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Dr K K Aggarwal

ECG not a reliable marker for predicting heart disease

By Dr K K Aggarwal
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Doing an ECG is of little use in predicting future heart problems for people who are examined because of chest pain.

Chest pain is the most common reason people seek medical attention for possible heart trouble, and an ECG is a common test for such people. ECG can be normal in the first six hours even in frank heart attacks. Missing the diagnosis of heart attack on ECG is the commonest mistake done in the emergency rooms.

The classical history and physical findings still remain the most important parameters.

  • Chest pain, which can be pinpointed by a finger, is not a heart pain.
  • Pain lasting less than 30 seconds is not a heart pain.
  • Heart pain is diffuse pain in the center of the chest lasting more than minutes and manifesting as heaviness, burning, discomfort, heaviness or pain often precipitated by physical or mental exertion.

Do an exercise stress test when in doubt; if negative, these patients should be reassessed for risk factors.

If the patient is at high risk, then even with negative treadmill, he/she should undergo risk reduction management for prevention of future heart attacks.

High risk patients are smokers, those with presence of high blood pressure, obesity, high cholesterol and diabetes.

Warning signs of worsening heart failure

By Dr K K Aggarwal
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If you have heart failure, call your doctor if you notice any of these signs:

  • Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up feeling short of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental confusion
  • Loss of appetite

Warning signs of worsening heart failure

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Warning signs of worsening heart failure

If you have heart failure, call your doctor if you notice any of these signs:

  • Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up feeling short of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental confusion
  • Loss of appetite
  1. Rule of 30 seconds: Chest pain, burning, discomfort, heaviness in the center of the chest lasting for over 30 seconds and not localized to a point unless proved otherwise is a heat pain. To this rule, add the rule of pin pointing finger i.e. any chest pain which can be pin pointed by a finger is not a heart pain.
  2. Rule of 5: If you suspect a heart attack, do not wait for more than five minutes and get to a hospital right away.
  3. Rule of 3: Reach hospital within 3 hours in case of heart attack to receive clot-removing angioplasty or clot-dissolving drugs.
  4.  Rule of 300: Chew a tablet of water-soluble 300 mg aspirin and take 300 mg clopidogrel tablets at the onset of cardiac chest pain (heart attack) to reduce mortality.
  5. Rule of 10: Door-to-ECG time is the time within which an ECG should be done in the emergency room and it should be less than 10 minutes.
  6. Rule of 30: Door-to-needle time in acute heart attack is the time before which the clot-dissolving drug should be given after a patient reaches the hospital. In ST elevation heart attack, the door-to-needle time should be less than 30 minutes.
  7. Rule of 40: First-onset acidity or first-onset asthma after the age of 40: Rule out heart attack or heart asthma.
  8. Rule of 90: Door-to-balloon time is the ideal time for primary percutaneous coronary intervention in acute heart attack by an experienced operator and should be less than 90 minutes.