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In women, the symptoms are often less
clear and chest pain is often absent
from the presenting history. More
vague symptoms such as sudden short-
ness of breath, unusual fatigue, general
weakness, sweating and dizziness are
often reported. Pain in the back of the
chest may be present. These acute
symptoms may often be preceded by
general fatigue, insomnia or shortness
of breath.
Initial treatment at home before the
arrival of the ambulance is keeping the
patient at complete rest in the most
comfortable position and having the
patient immediately take two 81 mg
ASA or an adult 320 mg ASA. There is
strong evidence that this reduces the
severity of heart damage. In fact, one
may not always be at home when an
attack occurs, so carrying a few fresh
adult ASA in an appropriate container
at all times is a wise move.
The Importance of Immediate
Care
Unlike many new medical conditions
that may not require an emergency call,
the onset of symptoms suggesting a
possible heart attack demand immedi-
ate action by calling 911 or the local
emergency number. Too many persons
delay such a call, often resulting in
more extensive heart damage or even
death. Even for snowbirds, the first
call should always be to 911, notifying
the patient’s insurer upon arrival
at hospital. Especially with seniors,
spouses should always take the lead
in making the call. Patients often want
to “wait and see what happens” or “try
the antacids first,” causing a poten-
tially dangerous delay in diagnosis and
treatment.
At hospital, an immediate medication
used for an acute heart attack is a
“clot buster “ drug, which has proven
to be very useful if given within the
first three to four hours after the onset
of symptoms. In addition, the urgent
action of examining the coronary
vessels by X-ray imaging (angiography)
within the first six hours may allow
for procedures to dilate the offending
artery (angioplasty). In this procedure,
the coronary artery found to be
obstructed might be opened or dilated
by stretching the narrowed vessel. As
well, a small expanding mesh may be
inserted to help renew and maintain
the circulation (stent). In the case of
more extensive narrowing, especially
multiple-vessel disease, bypass surgery
may be recommended. In the past,
bypass surgery was the main procedure
for occluded coronary arteries, but
most blocked arteries are now treated
by the simpler and safer procedure of
angioplasty.
Treatment as described above is now
fairly standard in modern facilities
and the outcomes have dramati-
cally improved over the past several
decades. Unlike the past, when the
patient was put to bed for six weeks
and physicians and family hoped for
the best, these modern medical and
surgical interventions most often result
in a quick recovery.
Medical Decisions for
Snowbirds
During this acute episode there will be
many questions, but even more facing
snowbirds. Am I really having a heart
attack and are this hospital and doctor
reputable? Why do they want to take
me for angioplasty? Is it necessary
now? Why are they recommending
bypass surgery when my friends have
had only stents? Is my insurer going
to approve payment for this care?
Why is the insurer talking about an air
ambulance home? These and many
other questions face such patients and
their family members.
Fortunately, most snowbirds reside in
areas that are near reputable medical
facilities. Ambulance attendants
know which hospital nearby is the
most appropriate for the particular
suspected condition. If the hospital
is not equipped to deal with a par-
ticular medical condition, the treating
physician – along with the assistance
personnel of the insurer – will select the
appropriate facility and the patient can
be transferred once stabilized.
Medical care in the U.S. is excellent,
but sometimes physicians are a little
more aggressive in ordering diagnostic
investigation and recommending
surgical intervention. For cases in which
this is suspected by the patient, family
Health