Ver la Versión Completa : Conozca REALMENTE los síntomas de infarto: En los minutos posteriores al infarto el daño cardiaco suele aumentar

Luis Di Mare
17/04/2012, 06:45
Conozca REALMENTE los síntomas de infarto para obtener atención rápida: Con los minutos transcurridos el daño cardiaco puede aumentar hasta ser irreversible o mortal. Muchas personas no buscan atención médica al tener un infarto

Es impactantes este artículo http://online.wsj.com/article/SB10001424052702304432704577347723157872672.html?m od=e2fb del Wall Street Journal (artículo que copio al final de este comentario): Sobran quiénes creen que si tienen un infarto tendrán un fuertísimo dolor en el pecho al estilo de los infartos de las películas de Hollywood. Pero solamente una parte de los infartos presentan dichos síntomas. Por ejemplo presión en el pecho sin dolor agudo e inclusive en mujeres síntomas parecidos a los del resfriado pueden ser síntomas de infarto.

La buena noticia es que un infarto no tiene por qué ser mortal ni tiene por qué dejar un daño irreversible (ver http://www.servier.co.uk/disease-information/heart-attacks/long-term-effects-and-complications.asp). Pero a medida que pasan los minutos el daño al corazón se puede ir acrecentando. Lo ideal es llegar al hospital en el lapso de una hora. Pero la gente llega en el lapso de 2 a 4 horas.

Típicamente un infarto ocurre por un coágulo en una arteria. A medida que pasan los minutos el daño al músculo cardiaco va aumentando. Debido al daño ocurrido en el músculo cardiaco el 19% de los hombres y el 26% de las mujeres mayores de 45 años muere en el año siguiente al primer ataque cardiaco.

El corazón es nuestra fuente de energía. Impresiona en el artículo cuántas personas tienen infartos y simplemente no reciben atención médica: Por ejemplo les da miedo hacer el ridículo y que lo que tengan no sea un infarto. Les da miedo pagar el costo de la ambulancia. Les da verguenza que los vean salir de la casa en un ambulancia. Puede ser que se nieguen a sí mismos que están ante un problema de salud realmente serio.

Lo que produce la muerte es el paro cardiaco: El corazón se detiene. Un paro cardiaco fuera del hospital tiene pocas probabilidades de sobrevivencia, menos de 8% de las personas logran sobrevivirlo. Pero un infarto no tiene que acompañarse de paro cardiaco.

El artículo cuénta cómo Carolyn Thomas, a los 58 años de edad, tuvo varios infartos no diagnosticados.

¿Qué sentido tiene dejar que la fuente de energía de nuestro cuerpo -el corazón- se deteriore, tal vez irreversiblemente, dejándonos semi inválidos -o muertos- simplemente porque no sabemos que tenemos un infarto? ¿Cuánta gente REALMENTE sabe cuáles pueden ser síntomas de infarto?

Pueden denotar un infarto estos síntomas:

-Fuerte dolor en el pecho (el infarto que muestran las películas de Hollywood) pero también pueden ser síntomas -sin ataque "tipo Hollywood"-:
-Presión en el pecho. Sensación de que le aprietan el pecho, sensación de opresión en el pecho
-Dicha sensación puede prolongarse hasta el brazo izquierdo o hasta la quijada
-Un estudio encontró que 71% de las mujeres experimentan síntomas parecidos a los del resfriado sin dolor en el pecho.
-Tanto hombres como mujeres pueden sentir indigestión, náusea, sudoración abundante, falta de aire por pequeños esfuerzos, fatiga abrumadora.

¿Qué hacer en caso de infarto?

-Reconocer los síntomas
-Llamar al 911
-Masticar una aspirina a la espera de que llegue el personal de emergencia

Ignoro qué tan bien funciona el 911 en Costa Rica. Pero el Wall Street Journal señala que en una ambulancia pueden empezar a tratar el infarto el cuál se trata con medicinas que reducen el coágulo. Además diagnosticar un infarto puede requerir de hospitales y especialistas.

Masticar aspirina es importante porque la aspirina verdadera (el Advil y el Tylenol no son aspirina y no tendrán el mismo efecto) contribuye a deshacer los coágulos de sangre que pueden causar un infarto.


El paro cardiaco -que causa la muerte- se puede prevenir teniendo un desfibrilador en la casa o en la oficina -cuesta alrededor de $1200.
La prevención del infarto se logra con ejercicio -10 a 30 minutos diarios- dieta, etcétera.

A continuación se copia el texto completo del artículo del Wall Street Journal http://online.wsj.com/article/SB10001424052702304432704577347723157872672.html?m od=e2fb
If You're Stricken, Minutes Matter, Yet Many Ignore Signs, Delay Treatment


Ron Winslow on Lunch Break looks at how to prevent a heart attack, and Melinda Beck discusses symptoms to look out for and what to do while waiting for paramedics. Photo: Getty Images.

The advice sounds very simple. The best way to survive a heart attack is:
1. Recognize the symptoms.
2. Call 911.
3. Chew an aspirin while waiting for emergency personnel to arrive.

But every year, 133,000 Americans die of heart attacks, and another 300,000 die of sudden cardiac arrest—largely because they didn't get help in time.
Of all the efforts to combat cardiovascular disease in the U.S., "this is our Achilles' heel, and it's the area where we've made the least progress," says Ralph Brindis, a past president of the American College of Cardiology.

Heart-attack sufferers fare best when they get to the hospital within one hour after symptoms start. But on average, it takes two to four hours for patients to arrive, and some wait days before seeking medical care. Reasons range from confusion to denial to fear of looking silly if they aren't having a health crisis after all.

Getty Images

"We've got this idea of not bothering physicians unless it's really necessary," says Angelo Alfonzo, a research scientist at the Yale School of Nursing and head of the Yale Heart Study (https://heartstudy.yale.edu/hacs/), which is exploring why people suffering heart attacks don't seek help faster. It hopes to have 2,300 survivors complete its online survey. He also thinks that social responsibilities play a big role. "If you ask people what they'd do if they had crushing chest pain, they say, 'I'd call 911.' But when push comes to shove, they're in a meeting or there's an event they can't miss. People find it very hard to drop everything."

Heart attacks, officially called myocardial infarctions, typically occur when a blockage forms in one of the coronary arteries, depriving part of the heart muscle of blood. Doctors can open the blockage with drugs or cardiac catheterization—but the more time that takes, the more heart muscle dies. "Time is muscle," as cardiologists say. Even if the initial heart attack isn't fatal, damaged heart muscle can lead to congestive heart failure—one of the reasons why 19% of men and 26% of women over age 45 die within one year of having their first heart attack, according to the American Heart Association.

Severe damage is bad enough. It can disrupt the heart's rhythm and lead to cardiac arrest, where the heart stops pumping blood. At that point, the victim has only a few minutes to live unless bystanders or paramedics restart the heart with a defibrillator or perform CPR.

Cardiac arrest often happens with no warning. Only 7.6% of people who suffer one outside of a hospital survive long enough to be discharged, a rate that hasn't changed much in 30 years, according to a 2010 University of Michigan study.
Recognize the Symptoms

With most heart attacks, victims do have some warning—but the symptoms can be confusing. The stereotypical "Hollywood heart attack," clutching the chest in agony, is only one scenario. The feeling in the chest may be more squeezing, tightening or heavy pressure. It may radiate down the left arm or up to the jaw or around the back between the shoulder blades, particularly in women. One study found that 71% of women experience flulike symptoms with no chest pain at all.


Both men and women may have indigestion, nausea, lightheadedness, profuse sweating, shortness of breath with little exertion and overwhelming fatigue.
"People whose heart muscle is shutting down often feel really tired, so they lie down and take a nap," says Dr. Alonzo. "That's not a good idea. They may not wake up."

Dr. Alonzo, who has studied behavior during heart attacks for 40 years, notes that people delay getting help longer when they're at home than in the office. At home, "you have more resources to use—you have your bed to lay down on, your favorite drink or your favorite comfort food. If you're at work, you tend to get out of there much faster, " says Dr. Alonzo, who titled one talk on heart-attack delays "Who's Going to Feed the Canary?"

"Thank God we have spouses," says Dr. Brindis. "I can't tell you how often, if it was left up to the patient, they never would have sought care." He says one cardiologist colleague thought he was having a heart attack, and ran up and down the stairs of his building to give himself a stress test. Turned out he was.

Some people call their physicians to discuss their symptoms—but experts say that only wastes more time. Even if you merely suspect you might be suffering from a heart attack, seek help as soon as possible. "It takes skilled physicians and nurses and lab technicians and often some kind of imaging tests to actually diagnose a heart attack, so there's no way you can diagnose it yourself at home," says cardiologist Janet Wright, executive director of the Department of Health and Human Service's Million Hearts campaign (http://www.aoa.gov/aging_statistics/docs/AoA_ACA_Slides_022812.pdf), which aims to prevent one million heart attacks and strokes in the next five years.

Call 911

Once they do decide to go the emergency room, only about 50% of heart-attack sufferers call 911 and arrive by ambulance, studies show. In the Yale Heart Study to date, 41% of respondents said someone else drove them, and 13% drove themselves.

According to Dr. Alonzo, some said they were worried about the cost of ambulance; others said they would be embarrassed to have neighbors see them taken away on a gurney.

But calling 911 has many important advantages. Emergency-medical technicians can perform CPR or use a defibrillator in case of cardiac arrest. Some can start intravenous fluids and give medications. EMTs can also administer electrocardiograms to gauge the extent of heart damage and notify the hospital to have the appropriate equipment standing by. That can significantly cut "door-to-balloon time"—the time between when a heart-attack sufferer first arrives and his or her blocked artery is opened.

"Patients who are brought in my ambulance are treated differently by the medical team," says Dr. Brindis. If you do go to the hospital on your own, be sure you announce, "I think I'm
having a heart attack!" for immediate attention.

Take an Aspirin

It does make sense to take one adult-strength aspirin, which prevents blood clots and may help keep an artery partially open. Chewing it will get it into your bloodstream quicker than swallowing it. The brand doesn't matter, as long as it's uncoated. Tylenol, Advil and other pain-relievers that aren't aspirin-based won't have the same effect.

If you have a history of heart disease or are at high risk for cardiac arrest, it may make sense to buy a home defibrillator, which costs about $1,200. "Cardiac arrest is what will kill you," says Douglas Zipes, another past president of the American College of Cardiology. "Having it in your home is a very cheap insurance policy."

The Right Recovery

Sadly, surviving a heart attack doesn't end with getting to the hospital quickly.

Cardiac-rehabilitation programs that offer exercise and diet plans along with education and support groups can help lower that risk. Many hospitals offer them, but they're under-used. In one study, only 14% of heart-attack survivors on Medicare enrolled.

PERSONAL STORIES: Vignettes from heart-attack patients.

Her Symptoms Overlooked

Women generally take longer than men to seek help when they have heart-attack symptoms--partly because they don't want to make trouble, partly because they have too much else to do and partly because some doctors brush them off when they do.

Carolyn Thomas of Victoria, Canada, was 58, experienced all three in 2008 when she had the classic symptoms—"crushing pain in the chest, nausea, sweating, pain down the left rm"—while out for her usual morning walk.

"I leaned against a tree, thinking, 'This better not be a heart attack because I don't have time for one,' " recalls Ms. Thomas, who worked in hospital communications at the time.
She went to the emergency room anyway, but was told her tests were normal. "The doctor said, 'You're in the right demographic for acid-reflux. Go see your family doctor," she says.

"I was so embarrassed. I left like I had wasted five hours of their time."

The pain returned, then subsided, on and off for days. Ms. Thomas, made an appointment to see her doctor, but didn't think it was urgent. "I knew it couldn't be my heart, because this guy with an MD just told me it wasn't," she says.

She went on a long-planned visit to see her mother in Ottawa. But on the way back, the chest pain got worse. She had two more attacks in the airport and two more during the five-hour flight home. She didn't notify the flight attendant "because I didn't want to make a fuss," she says.

When she landed in Vancouver, after midnight, she was too weak to walk and barely made her connecting flight to Victoria. "I kept thinking, if I can just get home, I'll be all right," she says. An airport staffer with a wheelchair helped her to her car "with me apologizing all the while," she says. It took her 20 minutes to gather the strength to drive home.
At the hospital the next morning, doctors said she had a 99% blockage in her left anterior descending artery—known as "the widowmaker," since blockages there are so often fatal.
"Notice they don't call it 'the widower-maker,' " says Ms. Thomas, who learned that men with the symptoms she had on her first visit would typically be kept for observation far longer.

Since then, Ms. Thomas attended a leadership program for women heart-attack survivors at the Mayo Clinic and started a blog, myheartsisters.org, to help educate women about heart disease.

Among the research on her site: a study in the New England Journal of Medicine showing that women are seven times more likely than men to be misdiagnosed in mid-heart attack and sent home from the hospital, and a 2005 poll from the American Heart Association that found that only 8% of family-care physicians and 17% of cardiologist were unaware that more women have died from heart disease than men every year since 1984.

Women do bear some of the responsibility for delays in care themselves. "Women think, 'Yes, we'll call the doctor after we pick up the kids and finish that report and put the casserole in the oven,' " says Ms. Thomas.

But she urges others to pay more attention to their bodies and their instincts. "You know when something is not right. That's what I didn't pay attention to," says Ms. Thomas. "The acid test is, 'If somebody that you love is experiencing these symptoms, what would you do?' "

Public-health officials also say that physicians need to be more aware of women's heart issues, and watch their bedside manner with false alarms.

Says Janet Wright, executive director of the Department of Health and Human Service's Million Heart campaign: "We need to work on medical personnel to say something like, 'You are not having a heart attack, but we're so glad you came in, and here are five things you can do to prevent one in the future.' "

Attack Wiped His Memory Clean

Fewer than 8% of people who suffer sudden cardiac arrest outside of a hospital live long enough to be discharged. James Wilson was one of the lucky ones.

In 1999, Mr. Wilson, then a 41-year old lawyer, was a Naval Reserve commander on active duty in Paris. He and his wife were on a bus heading to Monet's Garden when he said to her, "I don't feel good," and collapsed.

The bus driver gave him mouth-to-mouth resuscitation and restored his breathing while other passengers kept his heart beating with cardiopulmonary resuscitation until emergency-medical technicians arrived and shocked his heart with a defibrillator—twice—before his normal heartbeat returned.

Still, Mr. Wilson's brain had been deprived of oxygen for several minutes. He went into a coma that lasted three days. Then he was taken to an Air Force hospital in Germany, and medevac'd to Walter Reed Army Medical Center in Washington D.C..

Doctors there couldn't determine what caused Mr. Wilson's heart to stop beating, a common problem with sudden cardiac arrest. They suspected an electrical disturbance and implanted an internal defibrillator in his chest in case his heart stopped beating again.

The bigger problem, Mr. Wilson says, was that the lack of oxygen "caused my frontal lobe to be 'wiped clean,' as the doctors described it. I had more work to do getting my brain functioning again than anything I had to do with my heart." He had no memory of the event, the hospitalization or even being in Paris. He called a law firm he hadn't worked at for two years and asked for his messages.

Doctors at Walter Reed put his chances of returning to his work as a lawyer at 1%, but he beat the odds again. After four months of therapy to restore memory functions, he was cleared to practice law again. Even today, he still gets "small blips of memory, but I cannot be sure that it is legitimately my memory of being in Paris or something that comes from a movie or a magazine."

What caused Mr. Wilson's heart to stop beating is still a mystery. So far, his internal defibrillator hasn't been needed, though he does run 10K races to stay fit. His father suffered something similar years earlier. "I just hope that neither my son nor my daughter get the chance to see if it will happen to them," he says.

—Email HealthJournal@wsj.com

Write to Melinda Beck at HealthJournal@wsj.com

A version of this article appeared April 17, 2012, on page D1 in some U.S. editions of The Wall Street Journal, with the headline: Minutes Matter, Yet Many Don't Get Help as Symptoms Can Seem Harmless.

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