Aspirin and Heart Attack
WAHowland@AOL.COM
Thu, 17 Jun 1999 09:43:55 EDT
I am a nurse, as well as playing one at camp <G> and have a master's in
cardiovascular nursing, so this is my field!
Dave is correct in saying that an enteric coated aspirin would not be much
use for the immediate treatment of suspected heart attack (MI, myocardial
infarction). He is also correct in noting that old aspirin (ASA) smells
vinegary and is no good. Alas, the time you open up that little hotel sample
is not the time you want to find out the stuff you wanna snarf down right now
is no good.
However, if you are taking ASA every day (and, incidentally, one baby ASA,
about 80mg, is enough for daily) for clot debilitation purposes, then taking
another at the time you feel that crushing chest pain will probably not give
you any value added.
I hate it when healthcare people call them "blood thinners" because that
makes patients think of paint thinner or watered-down milk. Your blood is not
diluted by use of anticoagulants (the proper term, means "against clotting").
Anticoagulants decrease the ability of your blood to coagulate, to form
clots. And there are several different ones on the market, each with
different modes of action. (Of course they let your clotting mechanisms work
some, or you'd bleed to death when you brushed your teeth in the morning or
nicked yourself shaving.) Clotting involves an impressively large number of
processes, all of which have to be in good working order to make a simple
clot. You can disrupt the "clotting cascade" in many different places to
accomplish this goal.
Some meds, like ASA or persantine, decrease the ability of the platelet cells
to work less efficiently by making them less sticky, so they won't pile on
when they see a rough spot on the inside of an artery. This is useful for
people with known arteriosclerotic disease (crappy insides of arteries) in
coronary arteries or carotids (to your head) or other places. Some meds, like
heparin or coumarin, work against other parts of the clotting cascade in the
blood; these are most often given to people with increased risk factors for
clotting in non-useful places, like people with a tendency to grow blood
clots in their leg veins (thrombophlebitis, or phlebothombisis) or in their
heart chambers (atrial fibrillation). (Diabetics are often prescribed another
drug which makes their red blood cells more flexible so they can squeeze thru
crappy capillaries to deliver much-needed oxygen to tissues, but this has
nothing to do with anticoagulation.)
Clots in veins, venous thromboses, can break loose and travel thru the veins
to the heart and from there to the lungs, where if they're big enough they
can disrupt blood supply to the lungs enough to kill you. Clots in the atria
of the heart can travel out the aorta thru arteries to your brain or other
places like organs or limbs, where they disrupt the delivery of oxygenated
blood (stroke in the brain, other injuries depending on where the clot stops
blood flow).
Since most MI's are associated with clots (thrombosis) in the coronary
arteries, and clots tend to grow, the rationale for giving ASA with chest
pain is to decrease the chance that a clot will either form or, if already
formed, grow larger in a coronary artery. It's cheap as dirt, readily
available, and hits platelets pretty fast. ASA does not dissolve clot or
speed a clot's (normal) degeneration rate. There are drugs given IV which do
that, but you have to be in a hospital or a specially-equipped paramedic
wagon to get them.
End of today's lesson! Unless there are questions...
YiS
Auntie Beans
SA T47 Sandwich MA
Cape Cod & Islands Council
Abake MiSaNaKi Lodge #393
NSJ 1997 Nat'l Health & Safety
I useta be an Eagle...
'The staff is old and feeble, and we can sing no more,
So we're getting out of Gilwell while we can!'
NEI-188
<wahowland@iname.com>
