The burning question in minds of men and women during and immediately after a heart attack is, “Will I be able to go back to work?” “Will I be able to take care of my family?” It is difficult, if not impossible, for your doctor to tell you exactly what you will be able to do when you eventually leave the hospital, but if you understand the problem involved you may be able to help yourself.We must go back to the basic fact that your heart is a pump designed to pump blood. This muscular structure in a young adult has a phenomenal reserve capacity. On demand it may be able to pump seven or eight times as much blood per minute as it does when you are asleep. In other words, during extreme exercise your heart may be able to deliver 30 quarts of blood per minute to your body compared to the four quarts per minute that may be pumped during complete rest. As the years pass, the body ages and we are all aware that we no longer have, for example, the muscular strength that we had when we were twenty years old, nor at age sixty do we have the sense of sight or smell that we had when we were twenty years old.In a similar way the reserve capacity of your heart may be diminished by the process of aging. A person at age fifty may have a reserve capacity of five times, or possibly six times, the resting level of blood flow. We have stated previously that the result of a coronary thrombosis or myocardial infarction is the death of heart muscle. There is less heart muscle to pump the blood after a myocardial infarction than there was before the incident. The reserve capacity of the heart must, therefore, be diminished. This is the determining factor that will decide what you will or will not be able to do after your heart attack. If enough functioning muscle remains, you may be able to do practically the same things that you were able to do before your heart attack. This, of course, is particularly true if you had a large reserve capacity.The primary symptoms that you may recognize if you exceed your reserve capacity will probably be chest pain in the form of angina pectoris, fatigue, or shortness of breath on exertion. It is essential that the person who has recovered from a heart attack understand the factors that increase the demands upon the heart if he is to avoid difficulty and make the most of his physical impairment. The main factors that result in increased heart work are exercise, eating, emotional excitement, and extremes of temperature. Let us examine each of these in detail.When you exercise, as for example, taking a walk or hammering a nail, the muscles of your legs and arms are active and are doing work. This work demands increased food and oxygen to nourish the muscles of your legs and arms. Food and oxygen are carried to the muscles by blood that is pumped by your heart. Exercise, therefore, increases the work of the heart.The process of eating, and in particular digesting food, requires increased blood flow to the stomach and intestines. When food enters your stomach, the muscles of the stomach contract to mix the food with digestive juices and to propel the food to the intestinal tract. The intestinal tract also contracts to mix the food and to propel it further along. Great quantities of stomach acid and various digestive juices are poured into the intestinal tract to aid in digestion of the consumed food. These juices are produced by glands all of which depend upon blood for their raw materials. The production of digestive juices and the action of the intestinal muscles, therefore, require increased blood flow which must be supplied by the heart.A state of excitement or tension, anger, rage, or fear also results in increased heart work because these situations stimulate the adrenal glands, which produce adrenaline. The adrenaline circulates throughout the body and prepares the body for an emergency such as a fight or a flight (running away). The action of adrenaline upon the heart is to increase the rate of heart contraction and the work of the heart. A person who is frightened or angry, therefore, may have a heart that is working just as hard as if the man were actually running at full speed down the street.*12/309/5*

LIFE WITH HYPERTENSIONThe untreated person with persistent hypertension faces complications involving his heart, brain, and kidneys. The time necessary for hypertension to produce these complications is variable. Some may have hypertension for years without any serious complications, while others may develop an accelerated phase of the hypertension and have serious problems within a matter of months. Actually, any untreated hypertensive is susceptible to a sudden acceleration in the severity of his disease. This accelerated phase is called malignant hypertension. There is no relationship to cancer; the term malignant merely signifies that the process is virulent and getting worse.The cardiac response to hypertension is usually an enlargement of the heart, especially the left ventricle, the main pumping chamber. There is usually an accelerated development of atherosclerosis of the coronary arteries, and a heart attack or angina pectoris may occur. Eventually the heart may weaken, and the person will then develop heart failure, with shortness of breath and swelling of the body.In a person with hypertension, the blood vessels that supply the brain may intermittently narrow (vasospasm) with the resultant lack of adequate blood flow to parts of the brain. This may produce periods of confusion, actual unconsciousness, or intermittent periods of paralysis of one side of the body. The arteries usually also develop increased degrees of atherosclerosis, and this process may lead to the permanent occlusion of one of the vessels or to its rupture with bleeding into the brain. These events produce strokes, with paralysis or death.The small blood vessels that lie inside the kidneys can be affected by prolonged or severe hypertension. The response in these blood vessels is to deposit a coating on the inside of the vessel, which results in the vessels becoming narrower than normal. The kidneys then suffer from a lack of blood flow. This eventually produces gradual death of parts of the kidney, with ensuing kidney failure or uremia. As uremia develops in the hypertensive person, we frequently see that they lose weight and their appetite. They often become anemic, and edema or swelling of the lower parts of the body develops.With proper treatment, a hypertensive patient may have a near normal life span. This is particularly true if his problem is detected before any complications occur.Prior to 1950 there were very few effective techniques for treating hypertension. Sedatives were used to help lower the pressure in mild cases, but those people with malignant hypertension had an inauspicious future. The death rate in malignant hypertension took 80 percent of those so affected in the first year. Severe salt restriction helped some people. This was the era of the rice diet, or low salt diet.Then the Rauwolfia serpentina, or Indian snake root, entered the scene. Derivatives of this plant are still some of the principal agents used today to control blood pressure. A short time later the first of the modern diuretic drugs appeared. A variety of different diuretic drugs is now available. They act primarily by removing excess salt from the body. As a result, salt restriction is usually not necessary in the hypertensive patient. Additional drugs have been developed that block the blood pressure mechanism at different levels in the body. Agents may work primarily on the brain, the sympathetic nervous system, the small arteries of the body, or the kidneys. The stronger agents have side effects that may hinder their use in certain persons, but such a wide range of effective drugs are in existence today that the vast majority of hypertensive patients can now be adequately managed by one or more drugs.*60/309/5*

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