HEALTH MATTERS: The best post-heart attack treatmentA friend of mine recently suffered a heart attack and was given a clot-buster drug. He’s doing fine, but I thought that placing a stent was the preferred treatment.
By: Dr. Joshua Wynne , Grand Forks Herald
Q. A friend of mine recently suffered a heart attack and was given a clot-buster drug. He’s doing fine, but I thought that placing a stent was the preferred treatment.
A. All other things being equal, you are right that insertion of a stent in the blockage in the heart artery that is causing the heart attack is the preferred treatment method.
A stent is a Slinky-like sleeve that is placed in the artery during a heart catheterization. It opens up the blocked artery by propping the cholesterol and other debris in the artery against the wall of the vessel, and is successful in more than 95 percent of cases.
Fibrinolytic therapy — the clot-buster drug you mentioned — works to dissolve the clot in the artery that is causing the heart attack, but is successful only about 80 percent of the time.
And since a heart attack is usually the result of a clot forming on top of a cholesterol deposit, the clot-buster only gets rid of the clot, not the cholesterol deposit as does a stent.
So, why use the clot-buster? It’s because not every hospital has the facilities and staff to do stent insertion. So your friend probably was far from a stent-capable hospital, and if he couldn’t be transported to such a hospital in less than an hour or two, the clot-buster drug is preferred.
In heart attacks, time is of the essence — we say time is muscle, meaning the longer the artery is closed, the more muscle dies during the heart attack. A new law establishes a network of North Dakota hospitals to optimize the transfer of heart attack patients.
Q. I’m planning a trip overseas, but am worried about getting sick. What are the most common internationally acquired illnesses?
A. It depends on where you are going. Illnesses vary from annoying (like travelers’ diarrhea and rashes) to severe and life threatening.
Gastrointestinal infections are the most commonly reported diseases, with bacterial and parasitic causes of diarrhea more common for travel in Asia, Africa and the Middle East. Next most common are illnesses associated with a fever, most commonly malaria (especially in people visiting Africa).
Almost half of all patients with a febrile illness had no specific diagnosis established following a visit to their doctor, according to a recent report that looked at illnesses after international travel in more than 40,000 patients.
Next in frequency are skin ailments, often caused by animal or insect bites. Some of the dermatologic problems are serious, including concerns about rabies and skin infections because of parasites.
Least common are respiratory infections, often caused by a virus. Deaths are quite rare and most commonly the result of malaria. Many of the reported illnesses may have been preventable had the traveler had medical advice, vaccination or prophylactic medication.
Accordingly, you might want to check with your health care provider well in advance of your trip, especially if you have any chronic health condition.
A good source of information regarding health issues associated with international travel is the Centers for Disease Control and Prevention. Visit the website at wwwnc.cdc.gov/travel.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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