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  • Heart and mind: hormones
  • Coronary procedures
  • Cardio-vascular diagnostic workshop: what complaints and symptoms may indicate
  • Systolic and diastolic pressure
  • How to recognize angina and heart attack: the precipitating factors & anginal pain
  • Echocardiography: what information can the doctor get from an echo?
  • Heart and mind: medication
  • Angina
  • Can heart attacks and re-infarctions be prevented?
  • Echocardiography: what is a dobutamine stress echo?



    "Everyone can take care of his own car. All that is needed is some interest in caring for it, as well as buying the necessary Volkswagen tools and carefully following our directions. Special maintenance, however, involves more than such care because it requires technical skills, workshop equipment and specific tools."

    This text comes from a Volkswagen manual which is similar to the operating instructions of other cars. Careful reading reveals that a new car owner should have the routine maintenance done every ten thousand miles or at least once a year, and should not forget the lubrication and general maintenance required when car trouble develops.

    Our book may be regarded as an "operating manual" for your heart, for what is good for your car should certainly be right for your heart. You should be reminded of having your cardio-vascular system checked, especially if you are middle-aged or when you develop certain symptoms and if you learn of a heart attack in your family.

    What kind of tests should you anticipate when you visit your physician? Which kind of additional examinations are valuable? What is the potential outcome and prognosis of such examinations?

    Three situations are possible:

    You have no complaints but would like to know whether you are as healthy as you feel.

    You do have complaints and would like to know whether you

    suffer from ischemic heart disease. You would like to be informed on how such symptoms develop, what they signify and how they can be prevented.

    You have already sustained a heart attack and hope to prevent re-infarction.

    If you have no complaints, you should continue your reading on page 41 where the actual physical examination is discussed.

    If, however, you still have complaints persisting since your first heart attack, then you are probably interested in finding out whether these symptoms originate in the heart or in another organ.

    In any case, it is of utmost importance to you and your physician to find out the exact nature and causes of your symptoms. In 90% of the cases it is possible to determine the nature and cause of the symptom by questioning the patient. If you are interested in these questions, try to define and list your symptoms in the manner a physician would. The list on page 36 may serve as a guide.

    Experience has shown that such chest pains occur not only as a result of impaired circulation, but also in arthritic changes in the vertebrae of the neck or chest or even in the muscles of the chest wall and in the ribs where they join the breast bone. These complaints are also common in vertebral column complications causing pain in the arms, neck and shoulder. Usually the symptoms in the left chest cease when the complications involving the vertebral column have disappeared. Using X-rays the physician often detects changes in the spinal cord (degenerative changes) possibly combined with muscle cramps or functional difficulties. The patients are commonly under forty and those with "dyscardia" are mostly women, while those suffering from angina are predominately men.

    If the spinal column is the cause of the symptoms, the complaints usually occur when the head is held in a certain position, for example, when sleeping with a poor posture. The complaints disappear when the position is altered, after loosening up exercises, or gymnastics. These pseudo-heart symptoms must be treated in the same manner in which all complications originating in the vertebral column are treated, through prevention of great strain (long hours of uninterrupted typing, driving, or sewing), with relaxing exercises (morning gymnastics, walking or sports) and something which is typically taught in European spas,

    climate-therapy (alternating hot and cold showers, sauna, etc.). This program may be supplemented by massages of the connective tissues, use of heat, chiropractic measures and electrotherapy.

    It is possible to differentiate radiating pain which is a result of vertebral complications from that resulting from angina pectoris. Complications involving the vertebral column cause pain which typically radiates into the outer side of the arms and which occurs in certain positions, while true heart pain radiates into the inner sides of the arms and increases in intensity with exertion. Pain resulting from vertebral column complications is often felt in the right thumb, while heart pain radiates to the left small and ring fingers. Moreover, complications involving the vertebral column can be distinguished from those involving the heart by the use of medication. Ask your physician for a nitroglycerin capsule and bite the capsule to release its fluid the next time you feel the heart pain.

    Since the physical symptoms do not always appear directly after the emotional event, the patient usually does not associate his physical with his emotional complaints. It is now known that pseudo-cardiac disorders are usually caused by the trauma of separation. Dr. W. Brautigam explains: "If we examine the situation of the patient at the onset of his disease, we find that nearly all are characterized by a conflict of separation. The majority of patients were involved in an internal or external conflict with a mother figure at that time." Dr. H. E. Richter confirms "... that the onset of the disease coincides with a threat to a protective and dependent relationship the patient had cultivated. The 'heart neurosis' manifests itself at a time when either the patient or the other person involved in the relationship withdraws or threatens the relationship. . . . The actual dilemma for the patient is that he unconsciously revolts against his dependence on the relationship but fears destruction without it. The patient who often becomes sick when he feels he could become more independent is actually already more independent. It is as if he were being punished for seeking or attaining independence from a person to whom he had been closely tied. This punishment makes the patient even more helpless and impotent." Richter describes very typical examples of such a situation: A thirteen year old boy has a very domineering and overly protective mother. He experiences his first attack when he joins a friend on a bicycle tour from which his mother had tried to discourage him. At twenty-four years of age he experiences a further series of dyscardic attacks when the occasion of an examination allows him to leave his home.

    A twenty year old nurse visits her parents over Christmas. The visit culminates in a misunderstanding which is not resolved. After her departure she waits in vain for letters from her mother who had always corresponded regularly. As a result she develops dyscardic symptoms.

    A thirty year old married patient is unfaithful. Although he feels very close to his wife, whom he regards as a kind of mother figure, he is strongly attracted to another woman. He also develops dyscardic symptoms.

    In the event that you did not determine any risk factors in your case and responded positively to the questions on the right hand side of the questionnaire at the beginning of this chapter, answer the questions which concern the symptoms of dyscardia.

    It is possible that you have dyscardia if you answered more than half of the questions with "often" and, in addition, frequently feel fatigued, experience shortness of breath, feel trembling, faintness or weakness in your legs and arms, have insomnia and experience abdominal and intestinal discomfort. We have described dyscardic symptoms in detail since they may also appear after an actual heart attack. Not all complaints experienced after a heart attack can be attributed to attacks of angina pectoris and it is even possible to suffer from anginal pain and "dyscardia" simultaneously. These symptoms often persist stubbornly and torment the patient without involving actual changes in blood vessel walls. During the treatment which should proceed with patience, the emotional state must be determined. Patients suffering from both angina and "dyscardia" should be treated with graded exercise and possibly hydrotherapy as well as with an appropriate diet. The two types of patients should be distinguished only in drug therapy, although beta blockers are helpful in treating both angina and "dyscardia".

    After the physician determines your symptoms by questioning you carefully, he will try to establish your risk profile as you did yourself in the section entitled "Your Personal Risk Factors". He will ask about your smoking and eating habits, your work, possible stress situations in your profession and family, and also about how you relax.

    Questions about sports, hobbies and your spare-time activities form an integral part of the case-history. Hereditary factors must also be determined as part of the personal history. Typical questions include the age at death of your parents and the incidence of heart attack, stroke, hypertension, diabetes, gout and abnormal fat levels in the blood among close relatives. Is your family overweight, or normal weight, or thin?

    Do not be surprised if you must answer these questions on a lengthy and possibly computerized form. Your physician uses these carefully developed forms not only to save time but also to attain a higher degree of diagnostic accuracy. This way the physician is able to make a preliminary diagnosis which he will substantiate in the course of his conversation with you.


    Cardio & Blood


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