Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

9 Tammuz 5760 - July 12, 2000 | Mordecai Plaut, director Published Weekly








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Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Know Your Enemy

The next few columns will discuss the killers. Those who steal from us the weak and the infirm, while occasionally also murdering an unfortunate in the prime of their life. we know the killers by name. We've learned much about them, and can even interfere with their work, but they haven't been conquered yet.

The number one killer in the industrialized world remains heart disease. The heart is the only organ that is continually working, even when we sleep. It is just a muscle and its job is to act like a pump. Like all organs, it depends on oxygen and a good blood supply for its work. However, the arteries supplying the heart are small compared with the arteries of the big muscles of the body such as the leg. If these arteries get blocked -- the area they supply dies, and that is a heart attack. If enough of the heart is affected, or it occurs in an area of important electrical conduction, a person can chas vesholom die on the spot.

How do arteries get clogged? High blood pressure can cause mini tears in the artery wall which then can swell or fill up with cholesterol which for some reason fills areas of damage in the walls of the arteries. This narrows the walls, but the body can grow new arteries and bypass the narrowing. In people who exercise, there is lower blood pressure to start with, and bigger arteries. In smokers and diabetics, there is more disease in the arteries.

Now since the flow slows in areas that are narrow, the blood can sometimes clot. If a clot forms, the artery can no longer supply that part of the heart and if the clot doesn't move on, that part of the heart dies and a heart attack occurs. If it can be pushed further, some pain may occur which is soon relieved. This is called Angina.

In the past, we could do little for this problem except give medications that make the arteries relax and open up. Then in the seventies we started doing bypasses, where arteries from the leg were used to bypass the obstructions. Soon after, we were able to do catheterization, which is the injection of a dye into the arteries that allowed us to take pictures of the arteries and see where the obstructions were.

The late seventies began the era of clot busting drugs which dissolved the clot if used within 6 hours of a heart attack. In the nineties, we began doing catheterization emergently to open up the clogged arteries, and now we can put in Teflon stents which keep these arteries open. This is not available everywhere and is very dependent on the quality of the person doing it.

Who is at risk?

If you have had angina or a heart attack in the past, you are at risk. Also high blood pressure, heart disease in the immediate family, smokers, drinkers, those who are obese, people with high cholesterol, diabetics. Men are at higher risk before the age of menopause for women, but after menopause women have the same risk. Interestingly enough, women are unlikely to get the right therapy, for a number of reasons. Some say since the electrocardiogram is the fastest way to see if a heart attack is happening (although only 80% reliable) and women have smaller hearts, we don't see it as well on the EKG.

Of course, if you have any of the above risks, you should control them with medication and lose weight and exercise. Aspirin is protective and probably should be taken by everyone over the age of 35. Blood pressure and even heart attacks can be silent until it is too late. We'll talk more next week. Write me in care of the Yated.

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