About Heart Attacks

About heart attacks OMTEX CLASSES THE HOME OF TEXT About heart attacks A heart attack occurs when the supply of oxygen-rich blood to the heart is disrupted, usually by a blood clot in one of the coronary arteries that supply the heart with blood. The heart is composed of a special type of muscle that never rests and therefore has high oxygen requirements. When the heart muscle is deprived of oxygen for even a brief period of time, the myocardial tissue begins to die (infarct). Medically, heart attacks are known as myocardial infarctions.

Coronary artery disease is the leading cause of heart attacks in the United States, accounting for more than half of all cardiovascular events in men and women under the age of 75. Atherosclerosis is the leading cause of coronary artery disease. Sometimes called "hardening of the arteries," atherosclerosis is characterized by fatty plaque deposits that gradually block arteries, causing them to lose their suppleness. A blood clot can form after such a plaque deposit ruptures. Heart attacks can occur both with and without warning signs. Many people experience episodes of cardiac ischemia before a heart attack. Ischemia describes a lack of oxygen-rich blood. Ischemia may have no symptoms (silent ischemia) or it may be accompanied by a type of chest pain known as angina. In many cases, angina occurs at predictable times, usually during periods of activity when the heart's oxygen requirements are increased, such as after exercise. If the angina occurs at irregular or unpredictable times, and is not associated with exertion, it is known as unstable angina. This is a dangerous warning sign that a heart attack may be imminent. Depending upon the severity of the attack and of the subsequent scarring, as well as how rapidly the person gets access to medical service, a heart attack can lead to: •

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Full recovery, occurring in the majority of patients

Heart failure, a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body’s demands

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Electrical instability of the heart, which can cause a potentially dangerous abnormal heart rhythm (arrhythmia) Cardiac arrest, in which the heart stops beating altogether, resulting in sudden cardiac death in the absence of immediate medical attention

Cardiogenic shock, a condition in which damaged heart muscle cannot pump normally and enters a shock-like state that is often fatal •

Death

The location of the damage in the heart muscle is also important. Different coronary arteries supply different areas of the heart, thus the severity of the damage depends upon which artery was blocked, the extent of the blockage and how much of the heart muscle depended on that blocked artery. A heart attack is not the same thing as cardiac arrest, even though many people use the terms interchangeably. Cardiac arrest occurs when the heart actually stops beating and pumping blood. It is usually caused by an abnormal heart rhythm that causes the heart's main pumping chambers (e.g., ventricles) to quiver and contract irregularly (ventricular fibrillation). The term “massive heart attack” is also mistakenly used to describe cardiac arrest, but they are not the same thing. A heart attack may lead to cardiac arrest, but these are separate events. This invention relates to methods and products to abate coronary artery blockage in men and in women. These methods include administering a combination of natural hormones, including human growth hormone or recombinant human growth hormone, one or more sex hormones, such as testosterone, estrogen or progesterone and other naturally occurring hormones, as appropriate. The methods and products of this invention are disclosed in part in U.S. Pat. No. 5,855,920, issued Jan. 5, 1999, entitled TOTAL HORMONE REPLACEMENT THERAPY. The entire text of the '920 patent is incorporated herein by this reference. However, in abating coronary artery blockage in men and women, the methods of this invention additionally call for administering sufficient T3 thyroid supplement to maintain the body temperature of males and females with such blockage above about 97.6.degree. F. upon awakening, and is in the range of about 98.7.degree. F. to about 99.0.degree. F. during the afternoon hours. In addition, in treating males with coronary artery blockage, and with below optimal testosterone levels, these methods call for administering natural testosterone in gel form, preferably applied topically to under arm pits. In treating a human male or female subject who has blockage of coronary arteries, a treating physician preferably obtains the subject's records, including, where available, MRI, CAT scan, angiogram and all other pictorial and visual documentation of the blockage. The treating physician then measures the subject's total cholesterol, HDL, LDL, and triglyceride levels, and the subject's hormones in terms of growth hormone level as reflected through IGF-1 level, melatonin level, thyroid hormone level, thymus hormone level, adrenal hormone of DHEA level and pregnenolone level, and the

About heart attacks OMTEX CLASSES THE HOME OF TEXT subject's sex hormone(s) level (in males, testosterone; in females, progesterone and estrogen). In treating males or females presenting with coronary artery blockage, all of these hormones, if below optimal levels, would be administered to increase their bloodstream levels to optimal, as that term is used in the '920 patent. In addition, in male human subjects requiring testosterone supplement, testosterone would be administered in natural form, i.e. in gel form, not in synthetic form, such as testosterone types with prefixes or suffixes. In both male and female human subjects, the hormones administered include sufficient T3 thyroid supplement, in addition to the regular T4 and T3 thyroid supplements, to insure that the subject's body temperature is at or above about 97.6.degree. F. upon awakening, and is in the range of about 98.7.degree. F. to about 99.0.degree. F. during afternoon hours. The treatment continues until the coronary artery blockage has abated, as determined by tests such as MRI, CAT scan and/or angiogram Role of atherosclerosis in heart attacks Atherosclerosis is the single most deadly disease in the United States. At one time, researchers used to think of arteries as roughly analogous to plumbing pipes. In recent years, however, our understanding of arteries, and arterial disease, has been greatly enhanced. In fact, arteries are muscular organs that contract along with the heart to enhance blood flow and help maintain blood pressure. Arteries are highly sensitive to a number of chemicals and hormones that help regulate their function. These chemicals act upon, and are sometimes excreted by, the inner lining of the artery, or the endothelium. Researchers have learned that long before atherosclerosis becomes clinically apparent, this thin layer of cells has already been damaged and the earliest plaque deposits have already formed. Indeed, atherosclerosis often begins in early childhood, and it rarely is limited to the coronary arteries. In most cases, if a person has atherosclerotic plaque deposits in their coronary arteries, other arteries are also affected. The underlying defect, or cause, of atherosclerosis often remains unknown. However, researches have made great strides forward in understanding the process by which damage to the endothelial cells early in life can later evolve into a heart attack as an adult. It is now thought that the atherosclerotic process is mediated by immune-related inflammation. LDL cholesterol molecules also play an important role in the development of atherosclerosis. According to this theory, arteries are damaged, which provokes a local immune response at the site of the injury. White blood cells gather at the site of the injury and begin to secrete chemical messengers that cause inflammation. This is a normal immune system reaction that occurs in an inappropriate place. At the same time, the protective endothelial layer has been compromised, allowing LDL "bad" cholesterol cells to migrate into the inner layer of the artery. This further aggravates the injury, which causes more white blood cells to gather. Other fatty materials in the bloodstream (e.g., triglycerides) also begin to gather at the injury. Together,

About heart attacks OMTEX CLASSES THE HOME OF TEXT these materials combine to form a lipid foam. This foam forms fatty streaks.

Over time, these fatty streaks grow larger, eventually attracting circulating blood platelets and evolving into plaque deposits on the inside of the artery wall. Not all plaque deposits pose the same threat. Some plaque deposits develop a relatively hard "shell" of minerals in a process called calcification. These types of plaque are considered to be stable plaques. They are less likely to rupture and cause a heart attack. Other types of plaque are known as unstable plaques, which, in comparison to stable plaques, have the following: •

A larger fatty core

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More white blood cells encased within

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A thinner, softer, more unpredictable coating that might be stripped off without warning

The exact trigger of a plaque rupture is unknown. However, it can occur as a result of a strong, fast blood flow, especially during heavy exertion or emotional stress, when the coating is thin and the core of fat/white blood cells is particularly full. During a plaque rupture, the fatty core of the plaque deposit is exposed to circulating blood, while pieces of the plaque travel downstream into the artery. At this point, several different events might occur. The site of the plaque rupture might attract platelets, which start a clotting cascade and form a blood clot (thrombosis). This blood clot may grow big enough to obstruct blood flow. Alternatively, it may break off and travel down the

About heart attacks OMTEX CLASSES THE HOME OF TEXT artery until it becomes lodged in a smaller artery. Finally, the pieces of the plaque may themselves become trapped in an artery, blocking blood flow. Any of these scenarios results in a heart attack. The severity of the attack will depend on which coronary artery is blocked, how dependent the heart muscle was on that source of blood supply and the extent of the blockage. Researchers have found that almost 80 percent of first-time heart attack patients had ruptured plaque located both where the heart attack occurred and at other, distant sites. Researchers concluded that a heart attack is often not the result of one, discrete area of plaque damage. It may be separate areas of plaque rupture that combine to make the heart less stable and therefore vulnerable to a heart attack, a concept known as (pancoronaritis). Heart attacks may also be caused by a coronary artery spasm, a temporary constriction of an artery in the heart. Back to

Signs and symptoms of heart attacks Just as some people experience no symptoms during silent ischemia, some people can have a silent heart attack without knowing it. Up to 25 percent of heart attacks are symptom-free. The absence of symptoms, however, does not mean the absence of damage to the heart muscle. Unfortunately, people having a silent heart attack are unaware that they need to seek proper treatment immediately, and additional heart-related events or damage may occur. The majority of people who suffer a heart attack experience symptoms that are often severe and frightening. Recognizing these symptoms and realizing their importance is crucial. The vast majority (90 percent or more) of heart attack-related deaths in patients under age 55 occur outside of the hospital. Medical experts believe this is often due to the patient's lack of recognition of the situation. Younger people tend to ignore symptoms, whereas an older person may be more willing to call 91-1 at the first sign of trouble. Whatever the case, the sooner the symptoms of a heart attack are recognized and appropriate treatment is administered, the better the outlook for survival – both in the near future and over the long term. Symptoms of a heart attack may include:

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Chest pain that is unrelieved by rest and often spreads or radiates through the upper body to the arms, neck, shoulders or jaw

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Chest-area pressure, discomfort or squeezing sensation that may be either constant or intermittent

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Shortness of breath or shallow breathing

About heart attacks OMTEX CLASSES THE HOME OF TEXT •

Heart palpitations, in which the heartbeat is fast, strong or obviously irregular •

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Abnormally weak and/or fast pulse

Fainting (syncope) or loss of consciousness • •

Feeling tired or fatigued

Sweating, often with heavy chills •

Nausea or upset stomach •

Gray facial color

Women tend to have different heart attack symptoms than men. Although they may experience shortness of breath, weakness, unusual fatigue and cold sweats, they may not experience chest pain. They may instead feel pain high in the abdomen or chest, or in the back, neck or jaw. They may also experience dizziness. Many women have reported symptoms of unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety in the weeks leading up to their heart attack. Although one or a combination of these symptoms may indicate the onset of a heart attack, they may be due to other conditions as well. As a general rule, it is better to be safe than sorry. If a heart attack is suspected and any of these symptoms are present, this may indeed be a sign of a serious lack of oxygen-rich blood supply to the heart. Emergency medical help should be sought immediately. Physicians usually advise stricken individuals to first call 9-1-1, then to chew an aspirin (“regular” aspirin, not non-aspirin pain relievers such as acetaminophen) and wash it down with a glass of water while waiting for help to arrive. Prevention methods for heart attacks Risk factor modification is a major goal of prevention, both for first attacks and repeat heart attacks. Patients are urged to reduce behaviors that are associated with heart attack, such as smoking, and adopt healthy lifestyle habits that have been shown to prevent heart attacks, such as exercising and eating a heart-healthy diet. By altering these risk factors, it may be possible to slow the progression of atherosclerosis, which is the leading cause of heart attacks. The American Heart Association (AHA) recommends that people have their blood pressure, body mass index (BMI), waist circumference and pulse checked at least every two years, beginning at age 20. Cholesterol tests and glucose tests are to be checked at least every five years. Such risk factors, according to the AHA, can be used to estimate the risk of developing heart disease within a 10-year period. Specific recommended changes include:

About heart attacks OMTEX CLASSES THE HOME OF TEXT •

Improving your cholesterol ratio. A person’s total cholesterol level (which includes LDL cholesterol, HDL cholesterol and triglycerides) should be no more than 200 milligrams per deciliter and no more than five times the HDL level. Key strategies for reducing levels of total cholesterol, LDL cholesterol and triglycerides are to eat a heart-healthy diet and to exercise regularly. If these strategies do not reduce total cholesterol levels, a physician may prescribe cholesterol-reducing drugs (e.g., statins). Strategies for increasing levels of HDL cholesterol include eating monounsaturated fats in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program.

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Exercising regularly. Exercise can be an excellent tool in the both prevention of heart disease and improving quality of life for heart patients. Physically, it can slow or even reverse the process of atherosclerosis, as well as lower blood pressure and reduce cholesterol levels. Emotionally, it can reduce levels of stress and depression.

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Achieving and maintaining a healthy weight. Obesity and being overweight are major risk factors for a host of serious health conditions, including coronary artery disease, high blood pressure, diabetes, heart attack and stroke. Some weight control methods include limiting calories, increasing activity, counseling, medication and surgical interventions.

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Eating a heart-healthy diet. Modern research has consistently supported the idea that health is largely determined by what people choose to eat. Certain B-vitamins and minerals have been shown to be helpful to heart health. Omega-3 fatty acids found in certain fish (e.g., tuna, salmon and sardines) may keep arteries healthy and elastic. Saturated fats and tropical oils (palm and coconut oil), however, have been shown to be harmful, because they can speed up the development of coronary artery disease, atherosclerosis and obesity. Trans fat, in particular, has been linked to damage to the heart.

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Quitting smoking and avoidnig all second–hand smoke. Tobacco smoking is a major cause of coronary artery disease and cardiac arrest. According to the United States Centers for Disease Control and Prevention (CDC), from 1995 to 1999, nearly 450,000 people in the United States died prematurely from smoking. Of these, nearly 150,000 deaths were attributed to cardiovascular diseases and nearly 125,000 were attributed to lung cancer. The CDC also estimates that second–hand smoke was responsible for more than

About heart attacks OMTEX CLASSES THE HOME OF TEXT 35,000 deaths from ischemic heart disease (and 3,000 deaths from lung cancer) annually during the same five-year period.

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Controlling blood pressure. Individuals with high blood pressure (hypertension) are at greater risk of heart attack and other problems resulting from cardiovascular disease. Current research suggests that hypertension can bring on changes in genes involved in heart function. This contributes to a process known as remodeling, where there is enlargement and weakening of the heart’s left ventricle (left ventricular hypertrophy). Cells involved in heart muscle contraction become impaired and eventually self-destruct, leading to heart failure. Hypertension can be controlled through taking blood pressure medications, self-monitoring, eating a heart-healthy, lowsalt diet, and engaging in regular exercise. People are also encouraged to have regular check-ups with their physician.

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Controlling diabetes. People with diabetes may be more likely to develop heart-related diseases. Good glucose control is essential for all diabetics, as well as weight loss and a healthy diet. All type 1 diabetics will require insulin therapy, while type 2 diabetics can be treated with a number of additional medications that help control glucose levels. Non-insulin drugs used to treat type 2 diabetes include metformin and acarbose.

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Learning and practicing stress management techniques. Stress, excessive anger and fatigue can lead to high-risk practices such as overeating, smoking, high blood pressure (hypertension) and a lack of exercise. In addition, chronic stress may be a direct contributor to poor heart health because it produces increases in blood pressure that could become permanent. Anxiety has also been linked to an increased risk for future health problems in men who have suffered a heart attack.

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Avoiding high levels of homocysteine by getting enough B-vitamins. There is considerable debate over the role of homocysteine in heart disease. Homocysteine is an amino acid that is produced as a byproduct of other chemical reactions in the body. Numerous studies have shown that people with elevated homocysteine are at greater risk for heart attack, stroke and other cardiovascular problems. However, researchers have been unable to determine if elevated homocysteine levels are caused by heart disease, or if they cause heart disease. Also, two large, well-designed studies have recently shown that moderately lowering homocysteine among people with diabetes and existing heart disease had no effect on lowering risk for cardiovascular events. At this point, the AHA has not identified elevated homocysteine as a

About heart attacks OMTEX CLASSES THE HOME OF TEXT major risk factor for heart disease and does not recommend widespread use of folic acid and vitamin B supplements to lower homocysteine. However, because of the association between homocysteine and heart disease, people are advised to obtain these important nutrients through a healthy diet that includes fruits, vegetables, whole grain and fortified grain products. Additionally, people who have a family history or personal history of heart disease but lack other well-defined risk factors, such as smoking or obesity, should consider monitoring their homocysteine levels. In the event of elevated homocysteine (above 15 mmol/L), supplementation to lower homocysteine should only be done under the supervision of a physician to ensure the patient's safety. Folate supplements, for example, may mask a true vitamin B-12 deficiency. In addition, studies find that these supplements may increase the risk of artery re-narrowing (restenosis) following revascularization procedures such as balloon angioplasty and stenting.

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Recognizing and treating chronic depression. Depression has been linked with a higher risk of developing high blood pressure, heart disease and having a heart attack. Depression is associated with heart disease in several ways, including a risk of abnormal heart rhythms (arrhythmias), alteration of the amount of blood flowing to the coronary arteries, increased risk of blood clots (“sticky” platelets), and increased risk of sudden cardiac death. A recent study of the antidepressant drug sertraline found that it was a safe and effective therapy in patients having a recent heart attack or unstable angina. It has also been shown to have anti-clotting properties.

There is a great deal of information in the media about different vitamins, mineral, nutrients and other substances and their supposed affect on heart health. For instance, there are conflicting reports on whether high doses of vitamin E can protect arteries and prevent heart attacks and strokes, or whether high doses of vitamin E can actually damage the heart. Aspirin therapy, which may be prescribed for a patient after a heart attack, has also been touted as way to prevent a first heart attack. While recent research supports the theory, there are risks to the regular use of aspirin, including gastrointestinal bleeding. Patients with no history or significant risk of heart disease should discuss with their physician if the risks associated with aspirin outweigh the potential benefits. It is unfortunate that up to two-thirds of post-attack patients do not make lifestyle changes. It is estimated that up to one-third of fatal heart attacks could be prevented with the proper pre-attack medical treatments and lifestyle modifications. Even after one heart attack, the chances of avoiding future attacks can be increased with appropriate preventive care. People who have had a heart attack, or are at risk of having one, are encouraged to remember that their lifestyle choices can have a major impact on their heart health. Patients should always consult their physicians before making any changes to their diet or activity levels.

About heart attacks OMTEX CLASSES THE HOME OF TEXT

Much attention has also been given to the possible benefits of moderate alcohol consumption in lowering the risk of heart attacks and heart disease in general At this point, medical experts do not recommend that non-drinkers begin drinking alcohol for better cardiovascular health. Research is still being done to clarify the relationship between alcohol and the heart. However, findings in recent years have suggested that moderate alcohol consumption may offer some people a degree of protection against heart disease. Moderate drinking is defined as no more than one drink per day for women and no more than two drinks per day for men. One drink is equal to the following: 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor. Patients should discuss alcohol consumption with their physicians. In general, patients should follow established, proven wellness strategies. The earlier in life a patient modifies his or her habits, the better the chances of lowering or even eliminating certain risk factors for heart attack.

Diagnosis methods for heart attacks When a patient has symptoms of a heart attack, the physician will promptly evaluate the patient’s medical history and run tests such as:

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Electrocardiogram (EKG). A recording of the heart’s electrical activity as a graph, or series of wave lines, on a moving strip of paper or video monitor. The highly sensitive electrocardiograph machine helps detect heart irregularities, disease and damage by measuring the heart’s rhythms and electrical impulses.

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Blood tests. These can be used to detect the presence of certain markers that are released following a heart attack. These include troponin, myoglobin, creatine phosphokinase (CPK) and creatine kinase MB.

Once the patient is stabilized, the final diagnosis of whether the patient actually had a heart attack can take several days. Tests that may be run during this time include:

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Radionuclide imaging. A branch of nuclear medicine that introduces small, harmless amounts of radioactive materials (“tracers”) into the body. A special gamma camera is then used to scan the radioactive tracers and create visual images of the heart.

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Echocardiogram of the heart. This test uses sound waves to track the structure and function of the heart. A moving image of the patient’s beating heart is played on a video monitor, allowing the physician to study the heart’s thickness, size and function. The image also shows the motion pattern and structure of the four heart valves. During this test, a Doppler ultrasound may also be done to evaluate blood flow within the heart, revealing any potential leakage (regurgitation) or narrowing (stenosis) of the heart valves.