Signs and sypmtoms

Signs and sypmtoms of heart attacks are diverse
DEAR DR. DONOHUE: My father died of a heart attack when he was 47. His brother died of one at 45. Naturally, I am concerned. I am only 37, and I have four children and would like to be around when they graduate from high school. I have a simple question: How do I know when I'm having an attack? I need the particulars. — R.B. ANSWER: You have every right to have a healthy respect for a heart attack because of your family history. You can't do anything about your genes, but you can do much to lower the other risks for heart attacks. You should establish yourself with a doctor right now and be checked for blood pressure, cholesterol and blood sugar, and have an EKG and other heart tests. Heart attacks happen when a heart artery or arteries develop plaque — a buildup of cholesterol, triglycerides and scavenger cells. Plaque forms a mound on the artery wall. Some plaque is fragile. The top of the mound breaks loose, and the body tries to patch it by forming a clot on the raw surface. The clot obstructs blood flow and cuts off blood supply to the heart muscle — a heart attack. Heart attacks have a variety of signs and symptoms. Pain under the breastbone is common. People describe it as crushing. The pain can spread to the neck, jaw, shoulders and arms (left side more than right). The sudden onset of shortness of breath is another sign, and it might be the only sign in older people. Sweating, overwhelming fatigue, dizziness, fainting and nausea are other indications of a heart attack, and they may be the only signs of one. Fully one-quarter of heart-attack patients have little or no pain. They never know they have suffered a heart attack until an EKG is taken for a physical exam or some other unrelated reason. If people believe they are having an attack, they should have someone call 911 immediately. They also should chew and swallow a low-dose aspirin (75 to 100 mg).
DEAR DR. DONOHUE: I am in my mid-70s. I have osteoporosis and take medicine for it. To prevent excessive loss of calcium in the urine, the doctor also put me on Dyazide. Dyazide promotes increased production of urine and, therefore, more loss of calcium. Would you explain how it helps? — M.Z.
ANSWER: Dyazide is the combination of two water pills (diuretics): triamterene and hydrochlorothiazide. Both promote urine formation and increased urination. Hydrochlorothiazide has a unique property: It reduces the loss of calcium into the urine. A boon for you. Triamterene also has a unique property: It reduces the loss of potassium, something that often happens with hydrochlorothiazide. Another boon for you. The pamphlet on sodium and potassium explains these elements and their body function. Readers can obtain a copy by writing: Dr. Donohue — No. 202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I have been diagnosed with dermatomyositis. Other than referring me to a rheumatologist, my doctor hasn't told me much about it. I did have West Nile virus a few years ago and wonder if it has any relation to it. — J.P.
ANSWER: Dermatomyositis (DUR-mat-oh-MY-oh-SIGH-tiss) is a rare illness in which the immune system turns on the skin ("dermato") and muscles ("myo") and inflames them ("itis"). Muscle weakness and skin rashes are its prominent signs. The upper eyelids often take on a purplish color, and a red rash might break out on the face and upper trunk. Some have blamed this illness on several viruses, but proof is not absolute. West Nile virus has not been implicated. Prednisone, one of the cortisone drugs, is the usual initial treatment.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.