|
|
 |
 |
 |
| Friday, 2 July 2004 |
 |
|
 |
Features | |
| News Business Features Editorial Security Politics World Letters Sports Obituaries
|
Misdiagnosing heart attacks as gastritis - it happens Dr. D. P. Atukorale (Consultant Cardiologist) in reply to a patient's query on Gastritis, has come out with the possibility of doctors misdiagnosing heart attacks as gastritis and treating patients which could sometimes result in dire consequences. Mrs. K. Perera from Katupotha in a letter dated June 8 to Dr. Atukorale who is a member in our Medical Advisory Panel and who conducts our Health Watch Question Box, has stated. "My husband died recently of a heart attack, but doctors had treated him for gastritis, she has alleged; and wanted to know from the doctor - "How do we differentiate gastritis from heart attacks?" Dr. Atukorale in his reply states: Myocardial infarction (Heart attack) misdiagnosed as Gastritis Acute myocardial infarction (Heart attack) is very often misdiagnosed as acute gastritis by many doctors including physicians. When a heart attack patient presents with gastric symptoms such as nausea, vomiting and abdominal pain, these patients are very often treated with antacids such as aluminium hydroxide and are advised to see the family physician again in 2 or 3 days, if there is no response to antacids. Some of these unfortunate patients die at home whereas others get admitted to hospital where they receive treatment for myocardial infarction (heart attack). When I was in the Cardiology Unit During the 23 years I served as a specialist in the Institute of Cardiology, National Hospital, Sri Lanka (NHSL) I have come across hundreds of heart attack patients who have received antacids such as Digene before getting admitted to the Institute.
I know of a consultant attached to NHSL Colombo (which was called General Hospital, Colombo those days) who treated himself with antacids when he woke up one night with severe epigastric (upper abdominal) pain, and vomiting. In spite of his wife requesting him to get admitted to, General Hospital, Colombo, he continued to swallow more and more Digene and had a cardiac arrest and passed away at home. Heart attack patients get gastric symptoms A high percentage of heart attack patients (about 30 per cent) get gastric symptoms when they develop heart attacks. The gastric symptoms are more common in inferior wall myocardial infarcts than anterior wall infarcts. In any middle aged person who develops gastric symptoms for the first time of his or her life, his or her family physician should always exclude acute myocardial infarction (MI) by arranging for an urgent ECG, especially if the person has coronary risk factors such as diabetes, hypertension, smoking, high blood cholesterol, obesity and lack of exercise. Even if the ECG is normal, if the clinical features are suggestive of acute MI the family physician should admit the patient to a hospital where there are facilities for management of a MI. Once the patient is admitted to hospital the doctors will repeat the ECG and may arrange for certain biochemical tests such as estimation of cardiac enzymes and troponin T. Differences between Gastritis and Acute Myocardial Infarction (MI). (a) In case of myocardial infarct (MI) the patient appears extremely ill and usually has serve sweating and a pain radiating to the hands or neck and may have difficulty in breathing and giddiness unlike in case of gastritis where the patient is not so ill and there is no severe sweating. (b) In acute gastritis, the gastric symptoms such as abdominal pain and vomiting usually respond to antacids such as aluminium hydroxide dormperidone and ranitidine or omeprazole. In case of acute MI, the so called gastric symptoms usually do not respond to antacids. (c) In case of gastritis patient usually give a recent past history of taking drugs like aspirin, diclofenic sodium or indomethazine, or taking unwholesome food especially from a take away restaurant or taking alcohol. (d) Gastritis patients usually have severe tenderness in the upper abdomen. MI patients usually don't have tenderness in the upper abdomen. (e) In MI patients, the blood pressure may be low and pulse rate may be rapid or very slow whereas in case of gastritis, the blood pressure (BP) and pulse rate are usually normal unless the patient is dehydrated due to severe vomiting. (f) Doctors who auscultate the chest may hear abnormal heart sounds and rales in the lung bases in case of MI, whereas above findings are absent in case of gastritis. Premenopausal women with diabetes 30 times more likely to die from CVD According to the results of a recent British study funded by Diabetes UK, premenopausal women with Type 1 diabetes are at increased risk of death from cardiovascular disease (CVD). Researchers followed 23,751 men and women with diabetes for a period of up to 29 years, revealing that women under 45 yr with diabetes do not have anywhere near the levels of protection from heart disease seen among women without diabetes. Death from stroke was also significantly increased in premenopausal women. The study noted that women under 45 without diabetes have a very low risk of dying from heart disease but stressed that doctors should be aware of the increased risk to people with diabetes, so that unnecessary deaths can be avoided through early intervention. The findings will be published in Diabetologia later this year. An apple a day.... but why? The American Journal of Clinical Nutrition (Am J Clin Nutr 2002; 76: 535-540) reports that eating apples regularly may help reduce the risk of asthma, heart disease, lung cancer, stroke, and Type 2 diabetes. One apple contains as much soluble fibre as a piece of whole wheat bread or a half cup of raw broccoli. This type of dietary fibre has been shown to help maintain healthy cholesterol and blood sugar levels. Apples contain flavonoids - powerful antioxidants that are associated with reducing the risk for many diseases associated with aging such as cancer, heart disease, and Alzheimer's disease. According to nutrition researchers at Cornell University, almost all of the apple's disease-fighting potential comes from these phytonutrients. |
|
News | Business | Features
| Editorial | Security
Produced by Lake House |
