Q. My wife surprised us all recently when she suffered a mild heart attack--she had had no warning signs beforehand. Fortunately she did well. She had a coronary catheterization afterward, and they put in a stent to keep the blocked artery open.
We'd like to know what she can do now to keep from having another heart attack. We know that proper diet and exercise are important, but what medicines besides aspirin should she take? What else should be done?
A. You're right that aspirin can help prevent a second heart attack. Doctors recommend various doses, from 81 to 325 milligrams a day. If you can't take aspirin, you should take another drug that also "thins" your blood, keeping your blood's platelets from forming tiny clots that can block an artery already clogged with plaque.
Two other drugs that prevent clotting are Plavix and Ticlid. They're easier on your stomach than aspirin, but they're much more expensive and have other potential side effects.
The next type of medicine to take is a beta blocker. These medicines are usually started in the hospital right after a heart attack, and continued afterward. They improve short- and long-term survival, and help prevent a second heart attack. Beta blockers commonly used for this purpose are atenolol, metoprolol, propranolol and timolol.
Next are cholesterol-lowering drugs. Even if your cholesterol is in what's usually considered to be the normal range, cholesterol-lowering drugs can lower your chances of a repeat heart attack. The goal is to get your LDL cholesterol, the so-called "bad" cholesterol, below 100. Drugs known as statins are generally used for this purpose. Statins commonly used are pravastatin (Pravachol), lovastatin (Mevacord) and simvastatin (Zocor).
The next type of medicine is an ACE inhibitor. These drugs help prolong survival after a heart attack. They're especially helpful if you have any symptoms of heart failure--shortness of breath, fluid in the lungs, swollen ankles and so forth.
For women after menopause, estrogen replacement therapy is another treatment to consider. We don't have strong evidence that this helps prevent a second heart attack, but there's reason to believe that it does.
That may seem like a lot of medicines to take after a heart attack. But they not only help prevent a second heart attack and prolong life, they also help relieve any symptoms you might have, such as angina from blocked arteries or shortness of breath from congestive heart failure.
Besides taking medicines, you can also expect to have an exercise stress test to see how your heart's doing. This test is usually done within the first two weeks after a heart attack. It will check for any signs of blocked arteries in your heart, and see how well your heart functions when you're exercising.
The stress test will also give your doctor an idea of your prognosis. The results will enable your doctor to give you a good idea of what you'll be able to do as far as daily activities and level of exertion.
If you haven't had a cardiac cathetherization and an angioplasty or bypass surgery to treat blocked coronary arteries, the stress test would tell your doctor whether you should have a catheterization. The catheterization, in turn, would tell whether you should have a procedure to open blocked arteries.
Instead of or in addition to a stress test, some cardiologists will do an exercise echocardiogram or an exercise heart scan. These noninvasive tests will also show signs of blocked arteries and tell how well your heart functions under the stress of exercise.
Finally, early evidence suggests that taking vitamins C and E may help some people lower their risk of heart attack.
More on EarPlanes
Q. I'm writing in response to your request about people's experience using EarPlanes to prevent painful ears when flying.
For most of my life I've been plagued by incredible ear problems when flying. In addition to the pain, I would have decreased hearing, sometimes for days after a flight. I've tried everything, including decongestant pills, nose sprays, holding hot cups over my ears (not a good idea on a bumpy flight), chewing gum, swallowing, yawning and holding my nose and blowing.
I used to dread flying, even to the point of avoiding it if possible. Then one day someone told me about EarPlanes. I was skeptical at first, because they only cost about $5 and appeared to be just a pair of rubber earplugs. When I tried them on my next flight, I felt no pain whatsoever.
A. I received about 30 letters after asking readers whether EarPlanes worked for them. Everyone who responded said they worked. For most people, the response was dramatic--major relief of ear pain, even in people who had suffered for years with flying and had tried everything else. Some had had such severe ear problems from flying that they had seen several doctors, with no solution to their problem. In some cases, EarPlanes didn't entirely eliminate the pain, but they made it much more tolerable.
Although random testimonials are not the best evidence for how well a product works, there's not much information in the medical journals about EarPlanes. Judging from the response I received, they do seem to work in people when other methods of preventing ear pain haven't.
For more information on EarPlanes, contact the manufacturer, Cirrus Health Care Products, at 1-800-327-6151.
Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.