Tag Archives: heart attack

Straight, No Chaser: Aspirin – It’s Not Just for Heart Attacks Anymore

aspirin-for-heart-disease-and-prevention-of-cancer1-500x375

…not that it ever was! Aspirin has been known to be a pain reliever for thousands of years. Let’s take a brief look at the additional qualities that should make aspirin one of the meds you’d want to have if stranded on a deserted island.
Heart attacks: Many doctors routinely prescribe a daily aspirin to help prevent heart attacks. In fact, the research was so good that a Nobel Prize in medicine was awarded to those discovering that aspirin prevents the clot formation that leads to heart attacks. It has been estimated by the American Heart Association that up to 10,000 American lives would be saved every year if an aspirin (325 mg) was taken at the first signs of a heart attack. However, it is important to note that the US Food and Drug Administration (FDA) updated its recommendations to state daily use of aspirin should only be in those instances in which individuals already have cardiovascular disease, due to aspirin’s side effect profile.
Strokes: Aspirin has the same preventive effects on stroke development as it does for heart attacks, and daily preventive medicine is now part of many lives for that reason.
Cancer prevention: Aspirin appears to have preventative benefits for certain digestive cancers. Just this week, research published in the Annals of Internal Medicine finds that daily aspirin use at recommended levels for at least five years was associated with a 27% less likelihood of developing colorectal cancer. Additional evidence is strong for presentation of esophageal and stomach cancers, but outside of the digestive tract, conclusive evidence hasn’t presented of yet.
So if you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category, here are some logistical considerations about what to do.

Aspirin-tablet-300x300

1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an Alka-Seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

From the Health Library of SterlingMedicalAdvice.com: “If I stop smoking, what does this do to my risk for heart disease and stroke?”

Stop Smoking

 There are immediate and long term benefits to smoking cessation that extend beyond just lowering your risk for lung cancer. I challenge you to consider the following regarding lowering your risk for heart disease and stroke, and I’d bet you’d make the change to make yourself healthier.
  • Within 1 year of smoking cessation, your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.
  • Within 5–15 years after stopping, your risk of stroke has declined to that of a non-smoker.
  • At 15 years after stopping, your risk of coronary heart disease is that of a person who has never smoked.

You can do it. There are many great reasons to do so. You likely call some of these reasons family and friends.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Aspirin – It’s Not Just for Heart Attacks Anymore

aspirin-for-heart-disease-and-prevention-of-cancer1-500x375

…not that it ever was! Aspirin has been known to be a pain reliever for thousands of years. Let’s take a brief look at the additional qualities that should make aspirin one of the meds you’d want to have if stranded on a deserted island.
Heart attacks: Many doctors routinely prescribe a daily aspirin to help prevent heart attacks. In fact, the research was so good that a Nobel Prize in medicine was awarded to those discovering that aspirin prevents the clot formation that leads to heart attacks. It has been estimated by the American Heart Association that up to 10,000 American lives would be saved every year if an aspirin (325 mg) was taken at the first signs of a heart attack. However, it is important to note that the US Food and Drug Administration (FDA) updated its recommendations to state daily use of aspirin should only be in those instances in which individuals already have cardiovascular disease, due to aspirin’s side effect profile.
Strokes: Aspirin has the same preventive effects on stroke development as it does for heart attacks, and daily preventive medicine is now part of many lives for that reason.
Cancer prevention: Aspirin appears to have preventative benefits for certain digestive cancers. Just this week, research published in the Annals of Internal Medicine finds that daily aspirin use at recommended levels for at least five years was associated with a 27% less likelihood of developing colorectal cancer. Additional evidence is strong for presentation of esophageal and stomach cancers, but outside of the digestive tract, conclusive evidence hasn’t presented of yet.
So if you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category, here are some logistical considerations about what to do.

Aspirin-tablet-300x300

1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an Alka-Seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: Aspirin – It’s Not Just for Heart Attacks Anymore

aspirin-for-heart-disease-and-prevention-of-cancer1-500x375

…not that it ever was! Aspirin has been known to be a pain reliever for thousands of years. Let’s take a brief look at the additional qualities that should make aspirin one of the meds you’d want to have if stranded on a deserted island.
Heart attacks: Many doctors routinely prescribe a daily aspirin to help prevent heart attacks. In fact, the research was so good that a Nobel Prize in medicine was awarded to those discovering that aspirin prevents the clot formation that leads to heart attacks. It has been estimated by the American Heart Association that up to 10,000 American lives would be saved every year if an aspirin (325 mg) was taken at the first signs of a heart attack. However, it is important to note that the US Food and Drug Administration (FDA) updated its recommendations to state daily use of aspirin should only be in those instances in which individuals already have cardiovascular disease, due to aspirin’s side effect profile.
Strokes: Aspirin has the same preventive effects on stroke development as it does for heart attacks, and daily preventive medicine is now part of many lives for that reason.
Cancer prevention: Aspirin appears to have preventative benefits for certain digestive cancers. Just this week, research published in the Annals of Internal Medicine finds that daily aspirin use at recommended levels for at least five years was associated with a 27% less likelihood of developing colorectal cancer. Additional evidence is strong for presentation of esophageal and stomach cancers, but outside of the digestive tract, conclusive evidence hasn’t presented of yet.
So if you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category, here are some logistical considerations about what to do.

Aspirin-tablet-300x300

1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an Alka-Seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

From the Health Library of SterlingMedicalAdvice.com: “If I stop smoking, what does this do to my risk for heart disease and stroke?”

Stop Smoking

There are immediate and longterm benefits to smoking cessation that extend beyond just lowering your risk for lung cancer.  Consider the following regarding lowering your risk for heart disease and stroke, and make the change to make yourself healthier.

  • Within 1 year of smoking cessation, your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.
  • Within 5–15 years after stopping, your risk of stroke has declined to that of a non-smoker.
  • At 15 years after stopping, your risk of coronary heart disease is that of a person who has never smoked.

You can do it. There are many great reasons to. You likely can them family and friends.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Aspirin – It's Not Just for Heart Attacks Anymore

aspirin-for-heart-disease-and-prevention-of-cancer1-500x375

…not that it ever was! Aspirin has been known to be a pain reliever for thousands of years. Let’s take a brief look at the additional qualities that should make aspirin one of the meds you’d want to have if stranded on a deserted island.
Heart attacks: Many doctors routinely prescribe a daily aspirin to help prevent heart attacks. In fact, the research was so good that a Nobel Prize in medicine was awarded to those discovering that aspirin prevents the clot formation that leads to heart attacks. It has been estimated by the American Heart Association that up to 10,000 American lives would be saved every year if an aspirin (325 mg) was taken at the first signs of a heart attack. However, it is important to note that the US Food and Drug Administration (FDA) updated its recommendations to state daily use of aspirin should only be in those instances in which individuals already have cardiovascular disease, due to aspirin’s side effect profile.
Strokes: Aspirin has the same preventive effects on stroke development as it does for heart attacks, and daily preventive medicine is now part of many lives for that reason.
Cancer prevention: Aspirin appears to have preventative benefits for certain digestive cancers. Just this week, research published in the Annals of Internal Medicine finds that daily aspirin use at recommended levels for at least five years was associated with a 27% less likelihood of developing colorectal cancer. Additional evidence is strong for presentation of esophageal and stomach cancers, but outside of the digestive tract, conclusive evidence hasn’t presented of yet.
So if you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category, here are some logistical considerations about what to do.

Aspirin-tablet-300x300

1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an Alka-Seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, AmazonBarnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
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Straight, No Chaser: The Dangers of Shoveling Snow and Other Winter Chores

shovelheart-attack

You have probably heard it said, but you’d be surprised to know how often people hurt themselves shoveling snow. Of course, this time of year, people are doing many more strenuous activities than just shoveling snow. There’s walking (through mounds of snow), skiing, cross-county skiing, snow boarding, football in the cold, pushing cars that are stuck, scraping ice off the car and many other activities.
Is this really such a big deal? The important consideration is that you exert a lot of energy doing these activities. If your heart, back or overall health isn’t prepared to handle them, you can suffer debilitating consequences. Would you believe that every year over 11,000 people visit emergency rooms for back injuries related to shoveling snow?
Let’s address this in a way that is easy to understand. Shoveling snow can be even more vigorous than a full aerobic workout. It involves utilization and straining many muscles not often used by many people. It can lead to several ailments, ranging from strains and sprains to a herniated disk or a heart attack. Thus, if you’re going to do it smartly, certain rules should apply.

snow shoveling

Understand your risks. These winter activities I mentioned pose higher risks in the following groups, including an advanced rate of having a heart attack.

  • Individuals leading a sedentary lifestyle
  • Individuals having had a prior heart attack
  • Individuals with known heart disease
  • Individuals with high blood pressure or high cholesterol
  • Smokers

Here are some quick tips to lower your risk while shoveling:

  • Discuss your risk level with your doctor.
  • Wait until the snow has stopped falling.
  • Stretch and walk for a few minutes before starting. This will loosen and warm up your muscles.
  • Avoid eating, having sex, exercising or other strenuous activity for at least 30 minutes before shoveling, as your blood (and needed oxygen) will be diverted away from your heart. This is the basis of many heart attacks.
  • Avoid coffee or smoking for at least one hour before or one hour after shoveling or during breaks. These stimulants increase your heart rate and blood pressure, increasing the level of work your heart does and your heart attack risk.
  • Drink water before and after shoveling.
  • Dress warmly; cover your head, mouth and neck. Hypothermia and frostbite are serious issues.
  • Wear shoes that will prevent you from slipping and falling. Strains, sprains, and broken bones are one faulty step away in many instances.
  • Your equipment matters. Use a shovel with a bent handle. This angling will relieve the pressure on your back. Use a smaller shovel. It may take longer, but the lowered risk is worth it.
  • Push snow; try not to lift. If you have to lift, use your knees to take some pressure off your back.
  • Take your time and take breaks. If your body doesn’t feel right, stop.

Most importantly, KNOW WHEN TO STOP.
Do you know the warning signs of a heart attack? Be quick to seek medical attention if you feel out of sorts.
If you live in certain climates, winter chores are unavoidable. Arm yourself and your loved ones with these precautions. Your Sterling Medical Advice expert consultants are certainly available to answer any questions you have on this topic or when the need arises.

shovelingsmk

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