Why does the left side of the body ache during a heart attack

A heart attack is caused by the blockage of blood flow to a portion of the heart muscle tissue. Think about the pain that would occur if you put a tight rubber band around your finger. Within a minute or two you start to experience some pretty intense and intolerable pain. This is due to a lack of oxygen getting to the tissues of the finger. Your heart muscle actually starts to hurt when it's blood supply is blocked just like the finger. Since the largest part of the heart is situated to the left of the breast bone (sternum) in the chest, people tend to feel the pain on the left.

The pain associated with a heart attack can radiate too. It can radiate to the left shoulder, left arm and elbow and all the way to the fingers. Likewise, it may radiate to the right shoulder, arm, elbow or fingers. It may radiate up the neck on either or both sides and cause aching in the jaw(s). Sometimes the pain will radiate to the back.

Where the pain is located and where it radiates, if it does, can depend on what part of the heart muscle is being affected, or starved of blood supply and therefore, oxygen.

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What kind of condition would be appropriate for an urgent care visit?

Urgent care centers are open to care for the community without the need for appointment and they are open for extended hours providing services long after the doctor offices are closed.

Urgent Care centers are used for those conditions; both illnesses and injuries, for which you would usually go to your family doctor. This would include mild to moderate illnesses like coughs, colds, rashes, earaches, fevers, urinary tract infections, the flu, and even asthma attacks. Minor injuries like scrapes, sprains and pulled muscles would be another set of conditions seen best at the family doctor’s office as well as at an urgent care center.

There are even some conditions that the urgent care center can handle that many people might not expect. For instance, one might consider only going to an emergency room at a hospital for lacerations that need stitches and for minor or moderate burns and possible broken bones.

Many urgent care centers can expertly provide wound care including suturing lacerations, tetanus immunization update and caring for the initial management of minor and moderate burns. Urgent care centers that have Xray equipment can diagnose and then splint broken bones too. Chest xrays can be done to help diagnose pneumonia and other diseases of the chest also.

Many urgent care centers can do EKG’s.

Urgent care centers can often perform many routine lab tests right there at the center allowing you and the doctor to get results in less than 20 minutes.

Unlike your family doctor, though, the urgent care center doesn’t attempt to manage and regulate chronic conditions like diabetes, hypertension, cardiac disease or emphysema, just to name a few. On going follow up care is best done by the family doctor. Urgent care centers CAN however see you on an acute basis for these very same conditions when the need is urgent and you can’t get into your doctor. This is a part of the service urgent care centers are designed to provide to the community.

You need to know what your local urgent care center can handle in order to make good decisions about where to go when you are ill. Referring to their web site and/or calling them can answer many of your questions.

If a person comes into an urgent care center with a life threatening or critical illness, the urgent care center should stabilize the patient to the best of it’s ability while calling for ambulance transport to the ER.

REMEMBER
Any life threatening illness or injury requires an IMMEDIATE call to 911. True emergencies belong in the emergency room.

For everything else, however, the urgent care is a great alternative that will save you a lot of time and hopefully provide you with a much more pleasant and economical visit ...

... AND we do it all during convenient hours without an appointment.

Urgent Care Medicine -- Here to Serve the Community -- Here to Serve YOU



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I HAVE HAD A COUGH FOR MORE THAT 1 WEEK ... AT NIGHT IT IS WORSE SOMETIMES I WILL THROW UP . I HAVE BEEN COUGHING UP GREEN FLEM..AND HAVE SOME SLIGHT CHEST TIGHTNESS... COULD THIS POSSIBLY BE BRONCHITIS ?

This sounds very much like acute bronchitis but it could also be pneumonia. We recommend an exam by a physician who may order a chest x-ray to check for pneumonia if indicated by the findings of the exam.

Is there any rule of thumb on how long/deep a wound would be to require stitches versus simply treating with bandaging?

Generally speaking, if the laceration is deep enough to have gone through all the layers of the skin exposing the fat tissue or muscle, it will require stitches, also known as sutures. Another consideration is whether or not the wound stays together by itself as opposed to gaping wide open. Gaping wounds should be sutured because they will never close by healing the edges together. Instead, these gaping wounds will heal from the bottom up, filling in the gap slowly by a process called "secondary intention", taking weeks as compared to a wound closed with stitches which heals in a matter of days. We feel that this slow process can add to the risk of infection since the wound is open for so long.

Additionally, we want to take into consideration the location of the wound. For cosmetic reasons, facial wounds look better after healing if they are properly closed. Wounds that heal by secondary intention tend to have much larger, wider scars. Some locations of wounds, like on the knee or elbow should be sutured because of the tendency to pull the edges apart every time we move. These areas don't heal well if not sutured.

All wounds must be thoroughly and properly cleansed prior to closing and bandaging, otherwise we are covering up and closing in all the germs that entered the wound from the skin and in doing so we are providing a great place for them to grow and infect the wound.

When in doubt about whether or not a wound requires stitches, it is best to have a doctor look at it and give you his or her opinion.







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How many hours after an injury can you no longer get stitches?

There is no set time for how long is too long for stitches after receiving a laceration but the rule of thumb has historically been 5 - 6 hours. This was based, however, on a questionable study done about 50 years ago. Now a days, in reality, a doctor should look at it and make the decision whether it's been too long. Many times we can close a wound with stitches well passed the 5-6 hour "limit".


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how long does the tingly feeling last after a thumb has been severely cut? i had stitches on it and i thought things would be okay but its been almost 2 months after the cut and i still feel my thumb tingling. its kinda annoying coz its my left thumb so i couldn't write a single word. please help.

When you lacerate the skin you actually cut the tiny skin nerves at the same time and this will often leave one or both sides of the cut with a tingly feeling.

It takes these nerves anywhere from six weeks to six months to regenerate and get back to normal. Sometimes, however, normal feeling doesn't ever return. In most cases, you will get normal feeling back eventually. My rule of thumb is that if you don't have normal feeling after 12 months, it's probably not coming back.

Hope that helps.

What can you tell me about the flu and getting a flu shot?

The flu is caused by the influenza virus and is a respiratory illness.

Getting your flu shot, usually offered beginning in October, is very important especially for the elderly, the young and the immuno-compromised patient. In fact, in these types of patients the flu can be very serious and sometimes even fatal.

The flu shot is made from a killed virus, so the vaccine will NOT cause flu symptoms. Remember though, it takes two weeks to build up full immunity to the flu from the time you receive your shot.

Does the flu shot hurt? Well, if the vaccine is given with a small skinny needle, it's hardly even a pinch. Kids tell us that it didn't even hurt. So make sure your doctor uses something small like a 25 gauge needle. Your arm may get sore after the shot though, and the best thing to do is move it around and take some ibuprophen. Most people don't even need to do this however.

If you receive the nasal spray flu vaccine, you may have mild symptoms afterward because this kind of vaccine is made from weakened, or attenuated, virus. So, if you are at high risk for infections, such as in an immunocompromised state (AIDS, asplenia, undergoing chemotherapy), you should NOT get this form of vaccine. Have your doctor advise you because when in these high risks states, you should be vaccinated to protect yourself from the flu. In most of these cases the shot will be the proper choice for you. ASK YOUR DOCTOR.

Pregnant women should be vaccinated, but should get the SHOT, and NOT the nasal spray form.


FLU SYMPTOMS

When a person comes down with the flu, they may have achy muscles and joints. They will usually have a fever, head cold-like symptoms as well as a nonproductive, tight, wheezy cough, which are all hallmarks of the flu.

Associated symptoms range from sore throat and headache to fatigue and weakness. The flu lasts about a week. It is primarily spread through droplets from sneezes and coughing, and a person with the flu is contagious from one day before their symptoms show up through the five days after that.

Other more serious illness that in some respects may mimic the flu include pneumonia, sinusitis, strep throat and acute bronchitis. If you are coughing up colored sputum and your fever is greater than 101, it would be wise to go to the doctor, the urgent care center or even the emergency room. For information on how the “pneumonia shot” helps protect us, look for information here in the “Answers to Medical Questions.” For more information about the flu, go to www.cdc.gov/flu/keyfacts.htm.




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I'm concerned about lead exposure lately.

Recent recalls of products, specifically toys, produced in China have shed light on the dangers of lead-based paint and have a lot of people concerned.

The effects of lead can be mild to devastating in the human body. Symptoms and problems related to lead exposure can occur when exposure levels reach above 100 ppb in adults, but in children who are still developing, serious neurological problems can occur with blood levels well below the 100 ppb mark.

Symptoms of chronic lead toxicity can include anemia, neurological problems like slower or severely impaired mental development, reduced cognitive abilities, headaches, excessive lethargy and in really extreme cases, seizures and coma.

Milder, but serious symptoms, of lead toxicity include nausea, abdominal pain, irritability, insomnia, and a metallic taste in the mouth.

In cases of acute or recent exposure, symptoms may include constipation, diarrhea, vomiting, poor appetite and weight loss. Kidney and reproductive problems can also occur.

If you think you or someone you know may be suffering from lead exposure, you should talk to your doctor about being tested.




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What is the best way to treat food poisioning?

Food poisoning usually results in nausea, vomiting and diarrhea. It may present just like what we all consider to be the "stomach flu". It can be caused by bacteria or viruses contaminating the food we eat. Because of this, others that ate the same food as you will probably be sick just like you are. This part of the medical history investigation is important to know and will help you and your doctor figure out the cause of your illness. The symptoms can begin fairly quickly or take as long as 12 or 24 hours to appear. In most cases, the illness is self limited and will resolve in 24 to 48 hours, sometimes as long as 72 hours. Dehydration is a concern due to all the diarrhea and vomiting which can be severe at times. Rarely, food poisoning can be dangerous and even fatal due to toxins released by the contaminating bacteria. An example of this would be botulism which occurs in canned foods and begins with the progression of profound weakness and blurred or double vision. Luckily for us, botulism is easily prevented by cooking the food that was in the can or jar.

Most of the common food poisonings however, are simply the gastroenteritis variety in which we see the nausea, vomiting and diarrhea. Because these symptoms can be severe at times, especially for children and the elderly who cannot tolerate dehydration as well, you should see your doctor if you suspect you may have food poisoning. What you ate and where you ate are important too because if we begin to see a pattern with a particular type of food, or from a particular restaurant, we can notify the health department which will take steps to identify the tainted food source and remove it from the shelves in order to prevent more cases.

Allowing the stomach to rest for two to three hours with nothing taken by mouth will sometimes give enough time for the nausea, vomiting and diarrhea to subside. At that point, you can begin taking one ounce sips (half ounce for toddlers) of water every 30 minutes for an hour or so. If the sips stay down and you have no diarrhea as a result of them, you can begin to increase the amount of water by one ounce (half for the kids) each 30 minutes. If this fails, you should see a doctor who will be able to further evaluate you and perhaps prescribe some medication for the nausea and diarrhea in order to prevent dehydration.




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I have some questions about my child's fever.

We'd be happy to answer your important questions:

How high do I let my child’s fever get before I should get concerned?

Most fevers are not concerning. Most pediatricians consider any thermometer reading above 100.4 degrees Fahrenheit (38 degrees Celsius) a sign of fever. If your child has a fever it is probably a sign he or she is fighting a bacterial or viral infection. Fevers do not harm your child and may help your child fight the infection. Fever is a good sign that your child’s immune system is working and the body is trying to rid itself of the infection. If your child has a fever you may notice his or her heart rate will naturally speed up. She may appear flushed and perspire more than usual.

While most fevers don’t require a visit to the pediatrician or ER, there are certain circumstances when a fever could indicate something serious:

Looks very ill, is unusually drowsy or very fussy
Has been in an extremely hot place, such as an over heated car
Has additional symptoms, such as stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
Has had a seizure
Is younger than 3 months of age and has arectal temperat ure of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher




How do I do to treat my child’s fever at home?

A child who i s over 6 months of age and has a temperature below 100 degrees Fahrenheit (38 degrees Celsius) probably does not need to be seen or treated for the fever. Observe her behavior. If your child is eating and sleeping well, you may wait to see if the fever improves by itself. You can do the following to make them more comfortable:

Keep their room comfortably cool
Dress in light clothing
Encourage them to drink fluids, such as water, diluted fruit juices, or commercially prepared oral electrolyte solution
Do not let her over exert herself


You can also give your child some over the counter medication to reduce the fever. Both acetominophen and ibuprofen are safe and effective. The proper dosage must be given. Weigh your child and ask the pharmacist for assistance in dosing the medication. You may also sponge your child with lukewarm water.Do not use cold water or ru bbing alcohol.

Ibuprofen should only be used in children over 6 months of age. It should not be given to children who are vomiting constantly or dehydrated.Do not use aspirin. Aspirin has been linked to stomach bleeding and more seriously, Reyes syndrome.

Call your pediatrician or bring to ER if your child still “acts sick” once the fever is brought down, or if you feel that your child is very sick. Also call if the fever has been more than 24 hours in a child younger than 2 years of age or more than three days in a child 2 years of age or older.




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What are the signs of a heart attack?

A heart attack, or Myocardial Infarction, occurs when blood supply to a portion of the heart muscle is interrupted and the muscle tissue begins to die, or necrose, because of a lack of oxygen. Blood supply is usually interrupted in a heart attack by a small clot forming in one of the coronary arteries feeding the heart muscle. The clot usually forms at a very narrow spot caused by cholesterol plaque build up.

Classically, the signs of a heart attack include chest pain. The pain can be mild to severe and is often a pressure sensation like, "an elephant", sitting on your chest. The pain can instead be sharp, dull, burning or feel like indigestion or heart burn.

Associated signs and symptoms often include one or more of the following:

Shortness of Breath
Sweating: Clamminess to dripping wet
Nausea and sometimes vomiting
Lightheadedness or almost fainting
Marked weakness

Sometimes people will feel palpitations, or a fluttering in the chest along with the pain.

Often times the pain will radiate to the shoulder, the back, the jaw or down the arm. The arm can ache, feel numb, feel heavy or tingly. This radiation of "pain" can be on either side; left or right, or both!

It is important to remember that some conditions like diabetes can mask the pain and eliminate it all together. So, in those patients, feeling extra weak and having some of the associated symptoms mentioned above may be the only clue that a heart attack is in progress.

We have a saying in the ER:
Time is myocardium!

This means that the quicker you get the proper care for your heart attack, the less heart muscle will be damaged and the better the outcome. This can mean the difference between having a mild heart attack with only minimal problems, to having a major one associated with severe, debilitating side effects the rest of your life. It can also mean the difference between surviving a major heart attack or dying from one.

If you or someone you know is having any of the above mentioned signs or symptoms, you should call 911.




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My question is what drug besides TPA is used to dissolve a blood clot in an emergency room?

There are several medications available today. In most larger hospitals that have interventional cardiologists and a cardiac cath lab, the patient will have direct opening of the narrowed coronary artery by the cardiologist using a balloon on the catheter, or with a stent, thereby reversing the heart attack and preventing it from recurring.

In hospitals without that level of intervention, medications like TPA or it's more popular smaller molecule form called TNK will be used to dissolve the clot blocking the artery at it's narrowed, cholesterol plaque area, restoring blood flow to that portion of the heart, temporarily salvaging the heart muscle, and in effect, reversing the heart attack.

Examples of medications like TPA and TNK are Retavase, streptokinase, urokinase, and others.




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Hi, I get fluttering in my chest, I am on Lisinipril for High blood pressure (2.5 mg) I had the fluttering before going on the medication. I seem to get this quite often, no pain with it. I have had a stress test on the treadmill, cat scan and ekg, however none of these when this happens. I also have been getting off and on sharp and mild pains in my chest for a very long long time. Any advice?

Ask your cardiologist to perform a test called Event Monitoring. It will hopefully catch the fluttering beats so that he or she can analyze them and let you know if they are anything to worry about. The cardiologist will have recommendations for you based on what kind of irregularity in the heart rhythm you are actually experiencing. Another test that may be indicated is an echocardiogram. Discuss having both of these tests with the cardiologist. Neither is invasive (no needles). The Event Monitor is like a really small EKG that you stay attached to for 24 to 48 hours while you go about your normal daily life and the echo is like an ultrasound of the heart.

You should also have a blood test to make sure your electrolytes and your thyroid are normal. The cardiologist can order those tests too.

The sharp pains should be mentioned to the cardiologist as well. These could be related to the heart, but on the other hand, may not be. The cardiologist can help figure that out.

Thank you for your question.

Dr. Welch




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I HAD A HEART ATTACT AT 7:30 ON DEC.1,2004. I WAS AT MY LOCAL HOSPITAL IN 10 MINUTES AND WITH -IN THE HOUR I WAS STABELIZED AND TRANSPORTED TO TH VA IN MEMPHIS, TENNESSEE AND BEFORE NOON THEY HAD ME IN THE CATH LAB AND PLACED TWO SRENTS IN MY RIGHT CORONARY ARTERY. I WAS STILL IN THE PROCESS OF HAVING THE HEART ATTACT. MY QUESTION IS DID THEY INTERUPT OR STOP THIS HEART ATTACT?

A heart attack is when the heart muscle actually begins to die. It is completed when the muscle cells in the area of the heart attack are dead and can no longer function. In your case some of the cells may have died, but you may have had the blockages opened up before permanent damage and cell death occurred. It sounds as if you were still in the process of having the heart attack and even if some of the cells did die, the doctors prevented damage to a bigger area, thereby limiting the size of the heart attack.


Testing after the fact will be able to show if any of your heart muscle died. An EKG can show this and an echocardiogram, or ultrasound of the heart, will show even more evidence. If these are normal, then your heart made it through without damage. If they are a little abnormal, then it was affected slightly. As you can imagine, if the tests show that a large portion of the heart muscle was damaged, then that's what happened.

Talk to your cardiologist about how much, if any damage your heart received as a result of your heart attack. It sounds as if you sought and received treatment quickly, and this can make all the difference in the world in how much damage the heart attack does.

You responded to your symptoms as quickly as you could, and that's fantastic.

Thank you for this great question. I hope we have answered you satisfactorily.

Dr. Welch



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What is a stroke?

A stroke is a condition that causes death of brain tissue.

Brain tissue death is usually caused by interruption of blood flow to that tissue. This can be caused by a blood clot in a vessel blocking the blood supply to an area of the brain, or by the rupture of a blood vessel causing bleeding in the brain.

Strokes result from vascular disease.

Narrowed arteries with cholesterol plaque are easily blocked by a small blood clot.

Narrowed cholesterol filled arteries can actually cause clot formation if the cholesterol is brittle and develops small cracks in it's surface.

A weakening of an arterial wall can lead to the formation of a small aneurysm, or bulging area that may burst causing bleeding and loss of blood flow to areas of the brain supplied by that artery.

High blood pressure plays a large roll.

High blood pressure, over time, damages arterial walls leading to areas that allow cholesterol plaque to adhere and build up. Fluctuations in blood pressure can then crack cholesterol plaques attracting clot formation. High blood pressure can also cause an aneurysm to form and to later burst.

Strokes are sometimes called Cerebrovascular Accidents, or CVAs.

When a portion of the brain dies, that portion no longer functions and the person is left with a "neurological deficit". This can be a loss of sensation on one side of the body or face, a weakness or total loss of muscle use on one side of the body or face, an inability to speak, or a combination of all of these. Severe strokes can cause coma and death.

In many cases, the earlier a developing stroke is diagnosed and treated, the less damage is done to the brain tissue and the less the resultant permanent deficit. There are cases of strokes being reversed in the emergency department by use of clot dissolving medications.

As with many medical emergencies, when it comes to a stroke, the sooner treatment begins, the better the outcome.

At the first signs of a stroke, go directly to the ER or CALL 911. DO NOT WAIT.




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Why did I get pneumonia even though I had the pneumonia shot?

Pneumonias can be caused by a variety of bacteria such as Staph, Strep, Klebsiela, as well as other bacteria and even other kinds of germs.

Pneumovax, the pneumonia vaccine or Pneumonia Shot, protects you from Strep Pneumonia only. Strep pneumonia was the most common and is one of the most serious forms of pneumonia. The vaccine was developed to protect susceptible people from catching this particular germ and developing the pneumonia that it causes.

There are many other germs out there that can cause pneumonia. These range from viruses, such as those responsible for the common cold, to the one that causes chicken pox. Some of these, like the chickpox virus can be treated with special antiviral medications. Most viral infections must run their course as we do not have many antiviral agents for treatment. Some viral pneumonias however, can be severe and may require hospitalization in order to maintain adequate breathing and oxygen supply.

As we noted previously, pneumonia can also be caused by bacterias like those mentioned above. These are treated with antibiotics. If the infection is severe, these will be administered in the hospital and the patient's breathing and oxygen requirements will be supported too.

Additionally, pneumonia can be caused by tuberculosis and even some fungus.

Valley Fever is caused by a fungus that lives in the dusty desert soil. It is called coccidiodomycosis when it infects us and can cause a serious pneumonia. Special antifungal medications may be needed to fight off these infections.

"Walking Pneumonia", is the common term for a class we call "Atypical Pneumonias" and is caused by organisms such as Mycoplasma and Legionella. These respond quite well to certain antibiotics.

All pneumonias can be serious, some even life threatening.

Pneumonias are infections of the lung tissue itself. They can be painful because they inflame and irritate the tender lining covering the lungs. They cause fevers generally, shortness of breath and productive coughs.

You have luckily been protected from one of the most common and more serious forms if you've had the "pneumonia shot", but you may still come down with a pneumonia caused by the other germs.As we mentioned above, some of these can be serious .........

Therefore, don't hesitate to go to the doctor or to the ER if you are ill with a fever and cough, especially if you are coughing up yellow, brown, green or reddish sputum.

Remember too, we now know that the pneumonia shot is good forseven years at which time you will need to be revaccinated to continue your protection.

Who should be vaccinated? Generally speaking, people with compromised pulmonary systems like those with asthma, emphysema or chronic bronchitis. People with compromised immune systems also benefit from the vaccination. These would include people without a spleen, those on immunosuppressant medications, or those with HIV. Seniors in general are more susceptible to serious infection also and will usually benefit from being vaccinated.

Talk to your doctor about whether you need the pneumonia shot.




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Can you give us some facts about smoking?

FACTS

Smoking causes damage to the lining of the arteries. If you've read the answers to the questions above, you already know that leads to heart attacks and strokes.

Smoking causes less oxygen to get to all the tissues of the body even when you're not smoking, like between cigarettes and even when you're sleeping because of all the carbon monoxide you inhale and put into the blood stream every time you light up. Tissues that don't get enough oxygen don't work as well as they should. This includes YOUR BRAIN.

Smoking damages the lining of the lungs leading to irreversible pulmonary diseases like emphysema.

SMOKING GREATLY INCREASES THE CHANCES THAT YOU WILL DEVELOP LUNG CANCER.

Still, some people think smoking makes you look and feel cool around your friends.

Let's talk about being cool .........

Not being able to even go to the store without a tank of oxygen attached to your nose ISN'T COOL.

Having open heart surgery to fix your clogged arteries so you won't die ISN'T COOL.

Lying in bed unable to talk or move one side of your entire body for the rest of your life because of a stroke ISN'T COOL.

Lung cancer is way not cool. Don't EVEN go there -- you DON'T want too.

So get smart, be cool and DON'T SMOKE!

Look ............

HAVING THE RIGHT TO CHOOSE NOT TO SMOKE IS WAY COOL!

BEING SMART ENOUGH AND STRONG ENOUGH TO NOT SMOKE TO BEGIN WITH IS THE COOLEST.

HAVING THE COURAGE AND STRENGTH TO QUIT SMOKING IS REALLY HEROIC AND SHOWS GREAT STRENGTH AND PERSONAL INTEGRITY.

BE A HERO -- YOU CAN DO IT -- YOUR DOCTOR CAN HELP




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I’m under a lot of stress and I take blood preasure med, I sit at home and don’t walk or run but i know I need to, I’m 5'6 and weigh 202. I’m a 42 year old female. Can aspirin help as well? And do I need to lose weight to help me as well? Please get me the information to help me.

It is extremely important that you go to your doctor and have a thorough physical exam before any recommendations can be made.

Getting out for a walk every day, in general, is a healthy recommendation as is losing weight and maintaining your ideal body weight and body mass index. How gradually you work into the exercise will depend on many factors that only you and your doctor can determine working together after both a complete medical history and a physical exam are done.

Taking aspirin daily is also advised for adults over 40, but only if you are not allergic to it or have other conditions that might make aspirin the wrong choice.

So you see, it is very important to speak to your doctor. You AND your doctor need to make a plan for your health.




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