Word: ischemia
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...later back in Russia, Yeltsin, 64, was flown by helicopter from one of his dachas outside Moscow and rushed to intensive care at the Central Clinical Hospital in the city's western outskirts. The Kremlin announced that he was suffering from myocardial ischemia, the same blockage of the blood supply to the heart that early last summer had sent him to the hospital for two weeks and kept him out of work for nearly a month. For the next several days, Yeltsin was in virtual isolation, seeing only his doctors, family and bodyguards. His aides, looking somber, gave assurances that...
...Ischemia occurs when coronary arteries partly clogged with fatty deposits of plaque suddenly contract in spasms or are blocked by a clot, depriving the heart muscle of blood and thus oxygen. While painful or "noisy" ischemia (angina) often results from physical stress, like climbing stairs, even slight exertions, like balancing a checkbook, can trigger silent ischemia. During these episodes, which typically last a few minutes but can go on for ten hours, large portions of heart muscle can be damaged. Yet in more than 75% of all cases, for still unknown reasons, the victim feels no pain...
Then how is silent ischemia diagnosed? Doctors can detect attacks by monitoring electrical signals from their patients' hearts during exercise stress tests; a sudden decrease in blood flow to the muscle changes the signal. The condition can then be confirmed by a Holter monitor, a portable electrocardiograph worn by the patient for at least 24 hours...
Some doctors, after diagnosing ischemia, prescribe nitroglycerin, calcium blockers and other drugs that relax constricted arteries or slow the heart rate. Shell favors nitroglycerin patches applied to his patients' skin. "We don't have proof that this lowers the risk of heart attack," he says, "but anecdotally, I can tell you that my patients are doing better." Others have used bypass surgery (which allows blood to circumvent clogged arteries) or balloon angioplasty (to widen arterial passageways) against the silent attacks...
Doctors at the conference stressed that detecting silent ischemia will not merely prevent a few thousand dramatic deaths. It will also uncover heart disease in many people who are unaware that they have it. The stress and Holter tests are costly (about $200 each), according to Dr. Carl Pepine, a silent-ischemia expert from the University of Florida at Gainesville, but no more so than the toll ultimately taken by heart disease itself. Says he: "We're talking about the one disease that kills the most people in the country, many in middle age, when they are making their greatest...