Ornery Coronary
Whether you ride it or it rides you, that ornery, cantankerous coronary makes for bumpy going. It can turn an ordinary day into the likes of the O.K. Corral, with its sudden compromise of blood flow to the heart, commonly known as acute coronary syndrome (ACS). A chameleon by day, it takes many forms, none of them pleasant, ranging from unstable angina and myocardial infarction to sudden cardiac death and acute onset heart failure or pulmonary edema. Lungs fill with fluid, causing shortness of breath and a drowning sensation, and a pain in the chest becomes so intense and unbearable that even Wyatt Earp would whimper. All this because of a small thrombus of blood clotting cells called platelets, with a pinch of fibrin, coming to rest on a stump or plaque of atherosclerosis in a coronary artery.
Being fast at the draw means very little when the gunslinger is elderly, diabetic, afflicted with poor circulation, or subject to bouts of high nitrogen and cardiac enzymes in the blood, or wobbly and unstable electrocardiographic signs. A good saloon and a dancehall girl are no match for a stacked cardiac deck, and a posse of health professionals must intervene early and aggressively, if a tombstone over a lonely prairie plot is to be avoided.
Diagnosis of acute coronary syndrome in its various disguises is actually quite simple and straightforward, regardless of whether bandanas have been pulled high to mask symptomatology and impending cardiac holdup. Chest pain, electrocardiographic findings, two or more episodes of angina within the preceding 24 hours, and elevated serum, cardiac biomarkers and enzymes specifically point to its likelihood, like smoke signals billowing from a high mountain pass, Kemosabe.
When acute coronary syndrome is suggested, patient care should not be left to chance or a roll of the dice or tumbleweed. An antithrombotic and anti-ischemic regimen should be instituted immediately in order to tame the raging thrombosis, reduce the constriction of coronary arteries, and help cardiac muscle make more efficient use of the limited oxygen supply available. Aspirin and heparin therapy should be initiated to prevent clotting, and nitroglycerin and beta-blockers to increase blood flow and reduce ischemic episodes.
With a new sheriff in town, law, order, and risk factor management can be maintained, and the shadier elements of the underlying atherosclerosis held in check by judicious use of weight management protocols, diet, statin drugs, smoking cessation advice and counseling, and increased physical activity, not to mention blood pressure control and diabetes management, when necessary.
And if six-guns start blazing and the cavalry is called for, diagnostic coronary angiography and angiographically directed revascularization can lead the charge, to the sound of a bugle call, within 48 hours of symptom onset.
The day is done, our hero rides slowly off into the sunset of a human cardiovascular system, and, while he didn’t get the girl, he made sure as hell that the girl (or boy) would live to see another dawn, or perhaps many more.
Being fast at the draw means very little when the gunslinger is elderly, diabetic, afflicted with poor circulation, or subject to bouts of high nitrogen and cardiac enzymes in the blood, or wobbly and unstable electrocardiographic signs. A good saloon and a dancehall girl are no match for a stacked cardiac deck, and a posse of health professionals must intervene early and aggressively, if a tombstone over a lonely prairie plot is to be avoided.
Diagnosis of acute coronary syndrome in its various disguises is actually quite simple and straightforward, regardless of whether bandanas have been pulled high to mask symptomatology and impending cardiac holdup. Chest pain, electrocardiographic findings, two or more episodes of angina within the preceding 24 hours, and elevated serum, cardiac biomarkers and enzymes specifically point to its likelihood, like smoke signals billowing from a high mountain pass, Kemosabe.
When acute coronary syndrome is suggested, patient care should not be left to chance or a roll of the dice or tumbleweed. An antithrombotic and anti-ischemic regimen should be instituted immediately in order to tame the raging thrombosis, reduce the constriction of coronary arteries, and help cardiac muscle make more efficient use of the limited oxygen supply available. Aspirin and heparin therapy should be initiated to prevent clotting, and nitroglycerin and beta-blockers to increase blood flow and reduce ischemic episodes.
With a new sheriff in town, law, order, and risk factor management can be maintained, and the shadier elements of the underlying atherosclerosis held in check by judicious use of weight management protocols, diet, statin drugs, smoking cessation advice and counseling, and increased physical activity, not to mention blood pressure control and diabetes management, when necessary.
And if six-guns start blazing and the cavalry is called for, diagnostic coronary angiography and angiographically directed revascularization can lead the charge, to the sound of a bugle call, within 48 hours of symptom onset.
The day is done, our hero rides slowly off into the sunset of a human cardiovascular system, and, while he didn’t get the girl, he made sure as hell that the girl (or boy) would live to see another dawn, or perhaps many more.
© 2006, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/05/2006 09:12:00 AM
2 Comments:
Hi! Just want to say what a nice site. Bye, see you soon.
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