Panic attacks may hike heart attack risk
Mon, 01 Oct 2007 20:06:48 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - The rapid pulse and shortness of breath of a panic attack can feel like a heart attack, and it may signal heart trouble down the road, a study of more than 3,000 older women suggests.
Women who reported at least one full-blown panic attack during a six-month period were three times more likely to have a heart attack or stroke over the next five years than women who didn't report a panic attack.
The researchers took into account other risk factors such as smoking, high blood pressure, inactivity and depression and still found that panic attacks raised risk.
The findings add panic attacks to a list of mental health issues — depression, fear, hostility and anxiety — already linked in previous research to heart problems, said study co-author Dr. Jordan Smoller of Boston's Massachusetts General Hospital.
"Postmenopausal women who are experiencing panic attacks may be a subgroup with elevated risk," Smoller said. "Monitoring them and reducing their cardiovascular risk may be important."
The study, published in Monday's Archives of General Psychiatry, wasn't designed to explain the link, Smoller said. He speculated that a panic attack may trigger heart rhythm problems or that stress hormones released during an attack may harm the heart.
The findings don't surprise Susie Rissler, 51, of Terre Haute, Ind. A panic attack sufferer since childhood, she's also has had three mini-strokes.
"You feel like the whole world is caving in," Rissler said of her panic attacks, which can include a racing heartbeat and chest pains. "I've had shaking, sweating, curling up in a ball totally afraid to even look around. Panic attacks can really destroy a person in a lot of different ways."
Some of the reported panic symptoms may have been heart problems in disguise, Smoller said. Symptoms such as racing heart, chest pain or shortness of breath, experienced as a panic attack, may have been caused by an undiagnosed heart problem.
"One study doesn't settle a question," he cautioned. "The number of events seen in this sample is still relatively small." Forty-one of the 3,243 women in the analysis had a heart attack or death from a heart problem. An additional 40 had strokes.
The study, which enrolled women from 1997-2000 and followed them for five years, was funded by the drug company Glaxo Wellcome, which is now GlaxoSmithKline PLC. The company makes Paxil, an anti-anxiety drug. Some of the study's co-authors reported financial ties to that company and others.
The research relied on the women's memories, rather than doctors' diagnoses, which could be considered a weakness of the study, said Dr. JoAnn Manson of Harvard's Brigham and Women's Hospital. But Manson, who wasn't involved in the study, said it's likely the findings point to a real connection between panic and heart problems.
"It does tie together very well with what we know about the biology and physiology of the stress hormones," Manson said. "I think it does suggest that this is something to discuss with your doctor" for women prone to panic attacks.
Previous research has found that panic attacks are more common in women than in men. The researchers found that 330 of the women, ages 51 to 83 years at the start of the study, reported a full-blown panic attack during the previous six months. Of those, about 4 percent, went on to have a heart attack or stroke. That compares with 2 percent of the women who reported no panic attacks but who had heart attacks or strokes.
Once the researchers adjusted for other health factors, they found the heart and stroke risk three times greater among women who had panic attacks.
A full-blown attack was defined as a sudden attack of fear, anxiety or discomfort accompanied by at least four of 12 symptoms, such as shortness of breath.
Laura Kubzansky of the Harvard School of Public Health, who wasn't involved in the new study but does similar research, said stress hormones may cause immediate heart damage or wear-and-tear over time. During panic, "the body is flooded with hormones that in the short run help the body cope with an emergency, but in the long run take a toll," she said.
While treating panic with medication may help some people with the psychological distress, there's no evidence yet that medication alone reduces heart risk, Kubzansky said.
"We still don't know how best to address this or how reversible these effects are," Kubzansky said.
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On the Net:
Archives of General Psychiatry: http://archpsyc.ama-assn.org/
Special teams fight diabetic amputations
Mon, 01 Oct 2007 18:58:49 GMTBy LAURAN NEERGARD, AP Medical Writer
WASHINGTON - A stubbed toe can lead to having your foot amputated? It can if you're a longtime diabetic. And it can happen fast.
"Tuesday in the office, they're fine. Friday, they're in the emergency room with gangrene in a toe," says Dr. Peter Sheehan, diabetes chief at New York's Cabrini Medical Center.
It's a little-known statistic: Foot problems — wounds that won't heal, infections, warping bones — are the most common reason diabetics are hospitalized.
And many of the 80,000-plus amputations of toes, feet and lower legs that Americans diabetics undergo each year are preventable, say specialists who brought more than 900 health providers to a meeting last week to figure out how to do just that.
One recommendation: For hospitals to create diabetes limb-salvage teams.
It sounds simple. But it involves pairing specialists who seldom work side-by-side — like podiatrists and vascular surgeons — to shave weeks off the time it can take to get proper care for a festering foot.
"It gets them everything they need right away, without months of waiting while the wound is going downhill," says Dr. John Steinberg, a podiatrist with Georgetown University Hospital's limb-salvage team.
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels seriously damage blood vessels and nerves, eventually leading to kidney failure, heart disease and other complications.
Among them is a vicious trio: Foot ulcers that strike about 600,000 diabetics annually; loss of sensation in the feet called neuropathy that makes sufferers slow to notice they have a wound; and poor blood flow in the lower legs that makes the ulcers slow to heal.
Amputation may end the grueling cycle of unhealing wounds and infection on one limb. But those patients still face grim odds. About half will develop ulcers and infections in the remaining foot, and undergo more amputations. And within five years, more than 40 percent are dead.
Infection is the chief reason for amputating. But there are no firm guidelines on when a limb is beyond salvaging — and a 2001 study of Medicare-covered diabetics found large differences in amputation rates in different parts of the country.
Until recently, most research into diabetic wounds has focused on methods to clean them out and spur new skin growth.
The newer message: Check blood pressure in a diabetic's ankle before rushing to foot surgery. One in three diabetics over age 50 has a condition called peripheral arterial disease or PAD, where leg arteries become too clogged to get enough blood to the feet.
That's one reason that last week's meeting urged a team approach to saving diabetics' limbs: Whatever foot surgeons apply to heal a nasty ulcer won't work unless a vascular surgeon has first cleared clogged leg arteries.
"We are hostage to the blood flow," is how Dr. David G. Armstrong, a podiatrist at Chicago's Rosalind Franklin University of Medicine and Science, puts it.
Minimally invasive leg-clearing therapy — propping open clogged arteries with balloons and stents, or rooting out the sludge with tiny razors and lasers — is on the rise. But Dr. Richard Neville, Georgetown's vascular surgery chief, says many diabetics have such severe blockages that they need blood rerouted, using one of their own clog-free veins or artificial blood vessels.
Then can come what Armstrong calls the variety of "goops and gadgets" to apply straight to the ulcer.
What works best? Studies are under way to try to determine that, but Armstrong and Steinberg recommend old-fashioned debridement — scraping away dead tissue every few days — and a vacuum-sealing device that helps keep the wound moist. Certain dressings can provide a scaffolding for healthy cell growth from the inside-out.
Between those vascular and ulcer-patching surgeries, patients see a lot of other doctors. Endocrinologists get blood sugar controlled enough to allow surgery. Infectious disease specialists find the right antibiotic cocktail. Orthotists design casts and special shoes to keep pressure off the foot's weak spots.
Treating a simple diabetic foot ulcer can cost $8,000; an infected one, $17,000.
The main message for the average diabetic: Take off your socks and shoes at every visit to the doctor and ask that he or she examine your feet. Many doctors follow this government guideline, but almost half of diabetics don't get a simple foot check that could spot brewing problems in time to avoid a limb-threatening ulcer.
And ask about the ankle blood pressure test, called an ankle brachial index. New York's Sheehan says the simple test is a leading predictor of which diabetics will be hospitalized for foot ulcers, and the American Diabetes Association recommends that every diabetic over 50 get checked.
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Doctors report on heart attacks in kids
Mon, 01 Oct 2007 08:03:31 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Beth Meter is a cardiac nurse who has seen plenty of heart attacks, so when her son complained of sudden crushing chest pain that spread to his arm, she was certain he was having one.
Doctors at first didn't believe her. That's because her son had just turned 13.
A report from Ohio doctors documenting nine cases over 11 years in kids as young as 12 says heart attacks in children are a rare but under-recognized problem.
For Beth's son, Dan, it took a month to see a specialist who confirmed the diagnosis. Luckily, 1 1/2 years later, the Strongsville, Ohio, teen is on heart medicine but is doing well.
"Pediatricians need to understand that this is a true and real condition," Mrs. Meter said. "Don't just push aside any kid that's complaining of chest pain."
Dan Meter was among nine children included in a report by Drs. John Lane and Giora Ben-Shachar at Akron Children's Hospital in Akron, Ohio. All were stricken between 1995 and 2006 and most were treated at the Akron hospital. Lane treated a few of the earlier patients when he was at Rainbow Babies and Children's Hospital in Cleveland.
All lacked common risk factors for heart problems, such as obesity, family history, high blood pressure, unhealthy cholesterol levels and drug abuse.
The cause of their heart attacks was most likely a heart spasm that briefly cut off blood supply, Lane said. It is also a rare cause of heart attacks in adults.
All but one of Lane's patients were boys. Doctors are uncertain whether girls face a lower risk because there's little in medical literature about this type of heart attack.
Lane called it "an under-appreciated phenomenon." His report appears in October's issue of the medical journal Pediatrics.
Chest pain is a common symptom in children, but 95 percent of the time, it's not heart-related and it is rarely life-threatening, said Dr. Reginald Washington, a Denver children's heart specialist.
Muscle strains and stress are among common causes of kids' chest pain. Most heart-related chest pain in kids is caused by infections, structural abnormalities or problems other than heart attacks, Washington said.
He said the Akron doctors' report "does a good job of telling physicians" they shouldn't dismiss heart attack as a possibility in children.
Dan Meter said the pain hit him during seventh grade social studies class in March 2006. A teacher noticed he looked pale, and Dan figured it was a stretched muscle. He didn't tell his mom at first.
"I didn't think that could happen to a kid," said Dan, now 14 and in ninth grade.
His mother took him to the doctor the next day, then to the hospital, where the pain returned and spread to his arm. Staffers there dismissed her concerns about a heart attack.
Dan was hospitalized for two days. Despite abnormal blood tests and imaging tests, he was told he likely had a heart infection and was sent home. His pediatrician ultimately him to see Lane.
Lane said parents should consult a doctor any time a child has sudden chest pain. A heart attack in children is typically a crushing-type pain that radiates to the arm or jaw or neck — similar to adults' symptoms, Lane said.
It is uncertain what causes spasm-related attacks, which don't involve the issues usually seen — narrowed arteries with plaque that bursts, leading to a clot that blocks blood flow.
Some overweight children have signs of early artery disease. But it takes years for that to lead to clot-related heart attacks, said Dr. Dianne Atkins, an American Heart Association spokeswoman and pediatrics professor at the University of Iowa.
Patients in the Pediatrics report were diagnosed through blood tests that showed abnormal levels of an enzyme made by injured or dying heart tissue. Many also had abnormal heart-imaging tests. Both methods are used to diagnose heart attacks in adults.
"In most cases we didn't see any permanent long-term injury in the heart function," and none of the patients has experienced any long-term problems, Lane said.
Although Dan takes heart medicine daily and nitroglycerin pills when occasional chest pain returns, he still snowboards, shoots hoops and does other hobbies he enjoyed before the attack.
"I try to keep it out of my mind," he said. "I don't want to be known as the kid who had a heart attack."
Still, he has advice for other kids who experience sudden, spreading chest pain.
"Don't be afraid to tell someone because it's very serious," he said.
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On the Net:
American Academy of Pediatrics: http://www.aap.org
