Blogfinger

American Medical Association Morning Rounds prepared for Paul Goldfinger, MD.  December 22, 2015:

Warning symptoms may be common prior to sudden cardiac arrest.
The AP (12/22 ) reports that research published in Annals of Internal Medicine  suggests “a lot of people may ignore potentially life-saving warning signs hours, days, even a few weeks before they collapse” due to cardiac arrest.
On its website, CBS News (12/22,) reports that the study of 839 patients found that approximately “half of patients who have a sudden cardiac arrest first experience symptoms like intermittent chest pain and pressure, shortness of breath, palpitations, or fainting.”     However, “80 percent of them ignore their pre-arrest symptoms.”

Blogfinger Medical Commentary:  Paul Goldfinger, MD, FACC

This unusual research from Oregon examined over 1.000 victims of SCA (sudden cardiac arrest,)  ages 35-65. For over 800 of them, there was enough medical information to come to some conclusions about warning symptoms. We used to think that most SCA cases were sudden, with no warnings; but this trial says otherwise.

In this study, with data collected over 10 years, about half of the SCA victims had warning symptoms  (especially chest pain, shortness of breath, fainting, and palpitations) during the weeks prior to their cardiac arrest.   For those who sought help for such symptoms, they had the best chance of surviving.  For those with symptoms who waited to seek help, they did poorly.  By the time a 911 call for  cardiac arrest is made, the survival rates are poor—perhaps 10%, with about 30% survival for those who sought help.

Whether someone has a history of heart disease or not, such symptoms should be checked by going to an ER or even calling 911 if the symptoms are impressive (as described above.)   Don’t waste your time calling your doctor–you’ll probably get an appointment for next week or longer, or they’ll tell you to call 911. Don’t gamble and waste time.  Don’t be reluctant to go to the ER without delay. Better safe than sorry.

In addition to the kind of cases examined in this trial, there is certainly a significant group  “out there”  who are destined to have a cardiac arrest  (and we don’t know exactly how to identify them) who seek medical attention because of warning symptoms or because of increased cardiac risk, who get treated in one way or another, who don’t experience the SCA that was in the cards for them.

The process begins with diagnostic evaluations and then there are many interventions that have been shown to improve survival in treated patients—-everything from coronary stents/bypass surgery, implanted defibrillators, drugs including beta blockers, aspirin and statins plus a myriad of prevention modes , such at blood pressure control, diet, exercise and others.

We used to use the term “hearts too good to die” in discussing young victims of sudden cardiac arrest who have conditions where they basically have good heart function and who could have been saved if only their electrical instability or their blocked arteries had been recognized or if their high risk cardiac conditions without symptoms had been diagnosed.

Doctors need to know about prevention of cardiac death, but some physicians are not very interested in prevention.   Patients  and families must be aware!

Such diagnostic findings are especially true for middle aged males, who should be evaluated for coronary risk, even if they feel great. Paying attention to risk could prevent more SCA’s.  And this is especially true if someone has major risk factors (hypertension, smoking, diabetes, obesity, family history, inactivity, high cholesterol,etc.)

We spent years perfecting our patient education book on prevention and I beg you to get it and study it.  It’s now four years since we updated it, but the basics are valid.  Eileen and I first worked on that book and gave it away free when we had a grant from Merck. In 2011 we published the 4th edition ourselves, but we make pennies per copy, and we don’t care about that. It cost about $12.00 paperback online.

We will donate every cent to the AHA; So please get it and read it.   It was designed to be easy to understand, but also recognizing that lay people are smarter than most doctors think.  Go  Amazon or Barnes and Noble.com  and search under Paul Goldfinger MD.

So don’t ignore worrisome symptoms, and have your coronary risk profile checked.    And please don’t shovel snow.  (We will be posting our yearly article on that subject.)   Here is a link    Dangers of snow shoveling