Friday, November 11, 2011

Don?t ignore signs of A-Fib

St. Luke?s Health Watch

by DR. MARCOS DACCARETT

Atrial fibrillation, sometimes called A-Fib, is the most common heart rhythm disorder, yet thousands of people in the United States who suffer from atrial fibrillation may not be aware of the dangers.

A-Fib is best defined as an irregular and often rapid heart rate. During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly—out of coordination with the two lower chambers (the ventricles) of the heart.

unfortunately, many people may not be aware that they are suffering from atrial fibrillation, so the condition may go untreated, which can potentially lead to significant medical complications, including risk of stroke, heart failure and reduced quality of life.

the disorder is very common in people with cardiovascular disease. In combination with age, factors like high blood pressure, diabetes and heart failure lead to structural changes in the upper and lower heart chambers which trigger and foster atrial fibrillation.

There are an estimated 2.5 million cases of atrial fibrillation in the United States. It is strongly age-dependent; about 25 percent of people age 40 and older will develop A-Fib during their lifetime. those diagnosed with A-Fib are typically 65 or older, or are survivors of a heart attack and may suffer from conditions such as diabetes, obesity, high blood pressure and heart failure. the disorder causes a very fast, irregular heartbeat, leading to symptoms of weakness, fatigue, chest pain, shortness of breath and a sensation of a rapid heart rate or heart palpitations.

the biggest risk for those suffering from A-Fib is the danger of stroke. because the blood is not circulating in the upper chamber of the heart, it can pool, forming a blood clot that can potentially cause a stroke. A-Fib patients are about three to five times more likely to have a stroke. Left untreated, A-Fib can also lead to heart failure because the fast heartbeat can weaken the heart and eventually cause the heart muscle to fail. Each year in the United States more than 60,000 deaths are attributed to atrial fibrillation. A-Fib can come and go in some people, but others may be faced with a chronic case.

To treat A-Fib, doctors alter the heart’s electrical system with treatment that may include medication therapy, catheter ablations (nonsurgical treatment), minimally invasive and advanced surgical options and other interventions. See your primary care physician if you are concerned about A-Fib. There are multiple treatment options available that offer individualized care, specific for each patient’s need. A-fib symptoms can be similar to those of a heart attack. If symptoms are strong and persistent, call 911 immediately.

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Cardiologist Dr. Marcos Daccarett is a member of the team of cardiologists, surgeons and staff at St. Luke’s Center for Heart and Vascular Health.

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Friday, October 14, 2011

Dealing with allergies

St. Luke?s Health Watch

By Dr. Julie Lyons

Ahhchew! It’s that time of year again: allergy season. each year during the spring and fall, our clinic sees a burst of patients suffering from typical allergy symptoms: itchy nose, eyes and throat, sneezing and wheezing, cough and fatigue. as a sufferer myself, I know just how burdensome allergies can be.

Allergies are common in the United States; up to 40 percent of children and 10-30 percent of adults suffer from them. in Blaine County, the common culprits are sagebrush, which blooms in the fall, ragweed, which blooms in the late summer and fall, and willow, which blooms in the spring. Some exotic and invasive grasses also cause our residents trouble. Indoor triggers include dust mites, animal dander and mold spores.

There are several known risk factors that predispose us to developing allergies. these include family history of allergies, male sex, early introduction of food and formula, birth during pollen season, early use of antibiotics, smoking exposure during the first year of life and firstborn status. Allergies are less common in children under 5, and become more common as children start to enter school. in early adulthood, we also see a rise in allergy prevalence.

The more you are exposed to an allergen, the more sensitive you become. over time, less allergen is needed to cause significant symptoms, and the nose becomes more sensitive to all sorts of substances, including tobacco smoke, perfumes and chemicals. Allergies can significantly decrease a patient’s quality of life. Children with allergies may have more fatigue, decreased test scores during allergy season, higher rates of attention-deficit disorder, poor concentration and lower self-esteem. in adults with allergies, work productivity is decreased and patients have higher rates of anxiety and depression.

So how can allergies be treated? The first step is to accurately diagnose the disease. sometimes your primary care provider can do this based on history alone; do you sneeze every time you play in a sage field in the fall? Then maybe you have allergies. if the diagnosis is not clear, or a patient is not getting better with routine treatment, then skin testing may be helpful. Skin testing is the most convenient and least expensive screening method to detect allergic sensitization. Blood tests (traditionally called RAST testing) provide similar information as that obtained with allergen skin tests, though they are more expensive and less sensitive for the diagnosis of allergy to inhalant allergens.

once a diagnosis is made, there are three main components of treatment. The first is to avoid allergens. for some of us, that may be difficult; maybe we don’t want to give away the family dog or perhaps we work outside near sagebrush. The second part of treatment is pharmacotherapy (using drugs). The most effective single therapy is intranasal glucocorticoid sprays (like Flonase). Over-the-counter antihistamines can also help some patients with mild symptoms, but the older ones, like Benadryl, can cause significant sedation. Antihistamine nasal sprays are sometimes prescribed when other medications are ineffective. Steroid shots are no longer indicated for the routine treatment of allergies due to their potential for harmful side effects.

for the patient with severe allergies that does not respond to traditional treatments, immunotherapy is available. Gradual administration of increasing amounts of allergens over time helps to decrease immune response and alleviate allergic symptoms, but this takes one to two years of frequent shots to become effective.

Dr. Julie Lyons is board certified in family medicine. she is seeing patients at St. Luke’s Clinic in Hailey.

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Pamela Detrow was having lunch in Milwaukee when she suddenly broke into a cold sweat, became dizzy and felt her heart racing. Thinking this would pass quickly, she asked her friends to order her a salad and diet soda, then stepped outside for some fresh air. But within a couple of minutes, the symptoms became so profound that she dragged herself back to the table, unable to lift her arms or raise her head.

Detrow was having a heart attack that November day in 2009, but she didn’t know it.

For more on heart health, watch “A Barbara Walters Special: a Matter of Life and Death” tomorrow at 10 p.m. ET on ABC!

As it turns out, neither did the emergency room doctors at a nearby hospital. upon seeing that she was an avid exerciser with no heart problems, they diagnosed a panic attack and sent her off with anti-anxiety pills and medication to lower her blood pressure, which had increased that day.

“Because I was somebody who did not have a history of heart disease, I believed them, because I didn’t know any different,” Detrow told ABCNews.com. “I was aware of the heart attack symptoms with the crushing chest pain where you clutch yourself and fall over: the classic male symptoms.”

Detrow, 58, is a poster girl for a campaign launched this week to raise women’s awareness that atypical symptoms, such as profound fatigue, unfamiliar dizziness, cold sweats and unexplained nausea or vomiting, can signal that part of their heart muscle is dying, and they could die, too.

Heart disease is the No. 1 killer of women. An American woman suffers a heart attack every minute. Yet after years of public education programs, the message hasn’t penetrated.

When Detrow returned home to Washington, D.C., her internist sent her to a cardiologist, where, three days later, the symptoms returned. she underwent an angiogram that showed she’d had a heart attack but did not have blocked arteries. Doctors prescribed a daily aspirin, the powerful blood pressure drugs valsartan and metoprolol, and a low-salt diet. they told her that after some rest followed by cardiac rehabilitation, “I would be fine, and that’s what happened.”

Today, the former member of the new York Road Runners Club again enjoys 5K and 10K races. she notes the irony of having a heart attack when when her husband was the one with heart disease.

“My husband has been on blood pressure medications for umpteen years. when everyone heard about my heart attack, they asked ‘why you and not him?’”

In Health Watch:Most of the drugs on the market right now to treat Parkinson’s disease target the symptoms.But a new approach would actually slow down the progression of the disease.Wendy Rigby explains.in this lab at the UT Health Science Center, scientists are trying to find a new way to treat a disabling disease: Parkinson’s.Dr. Robert Clark and Dr. Syed imam have published a study in the journal of neuroscience that shows an exciting initial finding.The drug Gleevec, on the market now and used to treat chronic myeloid leukemia, may also slow down Parkinson’s.Dr. Imam says, ‘when we do experimental studies, we see that if you use that drug, it’s going to preserve the neurons that are affected during Parkinson’s Disease.’The initial studies in mice showed that Gleevec helped Parkinson’s by clearing up proteins that accumulate and destroy brain cells.Dr. Clark says, ‘I think we have an opportunity to develop a treatment for Parkinson’s Disease that will actually slow down the progression of the disease rather than simply diminish the symptoms.’The experiments here have been going on for three years now.while Gleevec is promising, it doesn’t penetrate the brain tissue as well as researchers would like, but other drugs in the same class may prove effective.Parkinson’s affects a half million Americans, and the incidence is rising.Dr. Imam says, ‘so we might not be able to completely cure the disorder, but at least we can slow it down in terms of its progression.’Use of the drug for Parkinson’s in humans is still years away.