How to recognise heart attack early ?

The symptom of heart attack vary from one person to another.Recognition of these symptoms are very important for early detection of heart attack The most common symptoms are

• Chest pain: Patients may experience tightness, heaviness or pain in the chestpain may be felt in arms, neck, jaw, back or stomach: for some people, the pain or tightness is very severe, while some people just feel uncomfortable
• Sweating
• Feeling of light-headedness
• Breathing difficulty
• Feeling nauseous or vomit
• Severe tiredness

If you experience the above symptoms donot hessitate , immediately seek medical help.Emergency ECG and Echo test is required to rule out the myocardial infarction

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Attention to patients on valproate

Sodium valproate is a drug used for seizure. It is a broad spectrum drug for seizure. It is used since 1960.

Uses of valproate

1. Control of seizure

2. Treatment of psychiatric illness

Following are the adverse effect of valproate.

Loss of appetite

Vomiting

Drowsiness

Ataxia and tremor

Alopecia (loss of hair)

Curling of hair

Increased blood ammonia

Rash

Low platelet count.

A serious but rare complication is severe liver damage. Those who have preexisting liver disease and who are on other drugs producing liver damage are at risk for valproate induced liver disease. If used in pregnancy it produce neurological disease in offspring. So it should be avoided.

Drug interactions

Special precaution should be taken in people on  the following drugs.

1. Phenytoin

2. Phenobarbitone

3. Carbamazepine 

4. Clonazepam.

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Common cold and its complications

Common cold is one of the most common disease in the community. that is caused by virus. It affect any age group and both sex. Affected patients usually present with the following.

1. Headache

2. Running nose

3. Sneezing

4. Sorethroat

5. Heaviness of head

6. Earpain

7. Malaise

8. Tiredness

9. Fever

10. Cough

11. Bodypain

Spread of infection

Spread of infection is through contaminated secretions on the hand, towels, droplets or through air. There is high risk of transmission from one person to other. Practice of good personal hygiene is very important to prevent spread of infection. Affected persons may use nasal mask to prevent spread of infection.

Management

1. Patient should take adequate rest.

2. Plenty of water intake should be advised.

3. Frequent steam inhalation to relieve congestion in nose and throat.

4. Paracetamol(acetaminophen) for symptomatic relief.

5. Antihistamineto reduce congestion.

Symptoms usually resolve in 4 to 10 days

Complication of common cold.

1. Asthmatic and COPD patients  experience exacerbation of symptoms.

2. Pneumonia.

3. Tonsillitis.

4. Sinusitis.

5. Infection and discharge from ear (otitis media)

6. Infection of eye(conjunctivitis) and redness of eye.

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Inhaler in the treatment of bronchial asthma.

Inhaler is the best way to prevent recurrent attack of asthma and to terminate the acute asthma attack. Inhaler deliver the precise amount of drug into the lung. The striking advantage of inhaler is that the maximum effect of drug is achieved by avoiding its side effects. Effect of drug is fully obtained, at the same time it is safe. It has rapid onset of action, acts within 1 minute.

Types of inhalers

They are mainly of 3 types

1. Spray or metered dose inhaler.

Medicine is delivered to lung in the sprayform. It is very effective and correct amount of drug is delivered even at single use hence called as metered dose inhaler.

2. Powder inhaler.

Drug is delivered in powder form.

3. Nebulizer 

They are used to terminate an acute severe asthmatic attack rapidly. Nebulizer can deliver large amount of drug  rapidly to the lung.

Drugs used in inhaler

They are of two types

1. Drugs that prevent asthma.

These drugs reduce the oedema in the airways and helps to open them, thus reduces recurrent attack of asthma. These drugs should be used for prolonged periods. These are steroid group of drugs.

Beclomethasone.

Budesonide.

Fluticasone.

2. Drugs that treat an acute attack of asthma.

They reduce oedema in the airways and rapidly open them thus terminate the acute attack, but they cannot prevent recurrent attack. Example include salbutamol group of drugs.

Tablets that contain both the above type of drugs are available they should be taken after doctors advice. Inhaler with baby masks are available for use in children.

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Significance of early diagnosis of heart attack

Chest pain is a Common complaint in  emergency department (ED). Approximately 5% of all ED visits or 5 million visits per year is due to chest pain .There is a wide range of etiologies Cardiac, Pulmonary, Gastrointestinal, Musculoskeletal. Distinguishing these causes matter because management vary  according to etiology.

When there is a block in coronary arteries that supply heart muscle it will produce heart attack .Most common manifestation is  cardiac pain which is called angina pectoris.

Key features of typical cardiac pain

From history 

Location : Pain can be central, left or right part of chest.

Timing : It can be gradual or sudden onset.

Provocation : By exertion.

Quality : Diffuse or constricting type of pain it can be an uncomfortable pressure, fullness, squeezing in the chest.

Radiation : Can radiate to back, neck and arm.

Severity : Severity vary from a scale of 1-10.

Associated symptoms : Breathlessness, sweating, nausea, fainting, feeling of impending doom, cold clammy skin may be present.

When the patient is asked to localize the sensation, he or she will typically press on the sternum, sometimes with a clenched fist, to indicate a squeezing, central, substernal discomfort (Levine's sign). 

                 Levine's sign 

Key Emergency Physical examination 

1. General appearance - Patients are usually anxious and restless.
2. Vital signs - Watch for hypotension or hypertension.
3. Heart - Examine the heart sounds is it muffled? regular? fast?
4. Neck dilated neck vein.
5. Abdominal distension.
6. Lowerlimb oedema and calf muscle tenderness.
7. All these features need not be present in every patients.

Whenever you have chest pain consider above mentioned points you should not ignore the chest pain if  at least one or two features are present  and attend the emergency department and do proper evaluation.Early diagnosis is important because if there is a delay in treatment  more than 6 hours, there will be irreversible damage to heart muscles.

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