Elevated Death Risk After Heart Attack

Risk of Sudden Cardiac Death Rises Greatly Within Month After Heart Attack

Heart attack patients face the highest risk of dying from sudden cardiac death within the first month after heart attack.

That's according to a new study by researchers from the Veterans Affairs Medical Center and Mayo Clinic in Minnesota. The study appears in the Nov. 5 issue of TheJournal of the American Medical Association.

Since 1997, the risk of sudden cardiac death has steeply declined. Even so, it still causes about 325,000 adult deaths each year in the U.S., all linked to complications from heart attacks.

Sudden cardiac death occurs when the heart's electrical system fails. The heart begins beating extremely fast, preventing the ventricles from allowing enough blood to flow throughout the body. Without blood going to the brain and other vital organs, a person quickly loses consciousness and soon dies.

To better understand this problem, as well as the impact of recurrent ischemia (an inadequate flow of blood to a part of the heart) and heart failure on sudden cardiac death, the researchers studied 2,997 residents who survived a heart attack in Olmsted County, Minn., between 1979 and 2005. On average, the patients were 67 years old, and 59% of them were men.

The researchers monitored the patients through their medical records until the time of their death or through the final follow-up in February 2008.

During this time, 1,160 patients died, with 282 of these deaths caused by sudden cardiac death. The rate of sudden cardiac death for patients who had suffered a heart attack within 30 days was four times higher than that seen in the general population. For each following year, however, the rate of sudden cardiac death was lower than expected.

The researchers also found that recurrent ischemia was not associated with sudden cardiac death. However, patients who experienced heart failure during the follow-up period had more than a fourfold risk of experiencing sudden cardiac death than the general population. This translates into an absolute increase in sudden cardiac death risk of 2.5% within 30 days of a heart attack and in each year thereafter.

"The risk of sudden cardiac death is the highest during the first month after myocardial infarction, when it markedly exceeds the rate in the general population," the authors conclude. "Among 30-day survivors, the risk of sudden cardiac death declines rapidly but it is markedly increased by the occurrence of heart failure during follow-up."

In other words, it's important to continue to monitor heart attack patients long after the initial incident because dire complications can still occur long after the initial heart attack episode.

On a positive note, the researchers noted an overall 40% decline in the incidence of sudden cardiac death over the course of the study, parallel with the major changes in treatment of heart attack survivors during this time.

Allergy medications: Know your options

Because you can't always avoid allergy triggers, you may need medication to help alleviate allergy symptom

Allergy medications are available in pill, liquid, nasal spray, eyedrop and skin cream (topical) forms. Some are available over-the-counter while others are available by prescription only.

The best medication or combination of medications for you depends on your symptoms, what other health conditions you have and what other medications you take. Certain allergy medications work better for some people than others. You may need to try a few different medications to determine which ones are most effective and have the least bothersome side effects.

To choose the best allergy medications for you, learn what's available to treat your symptoms — and work with your doctor to figure out what medications is best for you.

Corticosteroids

Type	Purpose	Side effects
Nasal sprays Examples include: Beclomethasone (Beconase) Fluticasone (Flonase) Triamcinolone (Nasacort) Budesonide (Rhinocort) Flunisolide (Nasarel) Mometasone (Nasonex)	These prescription medications prevent and relieve allergy symptoms such as nasal stuffiness, sneezing, and itchy, runny nose. For many people, these nasal sprays are the most effective treatment for allergy symptoms caused by hay fever or pets. It may take a few days or longer of regular use before your symptoms improve. Nasal corticosteroids are generally safe for extended use.	Mild side effects can include: Unpleasant smell or taste Irritation, especially during the winter Crusting and nosebleeds, especially in the winter
Eyedrops Examples include: Dexamethasone (Decadron, Maxidex, others) Fluorometholone (FML, Fluor-Op, others) Prednisolone (Pred Forte, Econopred, others)	Corticosteroid eyedrops are prescription medications used to treat severe allergy symptoms such as red, watery and itchy eyes caused by hay fever and allergic conjunctivitis. They are used for only a short period of time when other types of eyedrops don't work. You may be advised to avoid these medications if you are pregnant or plan to become pregnant.	These medications can cause: Blurred vision and other mild side effects Increased risk of eye infections, glaucoma and cataracts with prolonged use
Skin creams Examples include: Hydrocortisone (Cortaid, Ala-cort, others) Triamcinolone (Triderm, Kenalog, others)	These medications relieve the scaling and itching caused by eczema (atopic dermatitis). Some low-potency corticosteroid creams are available without a prescription, but you should always talk to your doctor before using any topical corticosteroid.	Side effects can include: Skin irritation Skin discoloration
Pills and liquids Examples include: Prednisone (Prednisone, Prednisone Intensol, others) Prednisolone (Prednisolone, Prelone, others)	Oral corticosteroids are sometimes used to treat severe allergy symptoms. Because they can cause serious side effects, they're usually prescribed for only short periods of time.	Long-term use of these medications can cause serious side effects such as: Cataracts Osteoporosis Muscle weakness

Leukotriene modifiers

Type	Purpose	Side effects
Pills and tablets Leukotriene modifiers are available only by prescription. They're produced in pill and chewable tablet form. Examples include: Montelukast (Singulair) Zileuton (Zyflo) Zafirlukast (Accolate)	These drugs block the effects of leukotrienes, inflammatory chemicals released by your immune system during an allergic reaction. Such medications have proved most effective in treating asthma, but montelukast also relieves hay fever symptoms.	Side effects differ for each type of leukotriene inhibitor, but can include: Cough Dizziness Headache Stomach upset or pain Stuffy nose Tiredness Insomnia Muscle weakness Liver damage (zileuton)

Cromolyn and mast cell stabilizers

Type	Purpose	Side effects
Nasal spray Available over-the-counter, the nasal spray cromolyn sodium (examples include NasalCrom, Children's NasalCrom) works best when you take it before your symptoms develop. Some people need to use the spray three or four times a day.	Mast cell stabilizer nasal sprays prevent the release of the symptom-triggering chemical histamine. They reduce symptoms associated with hay fever and allergic conjunctivitis.	This medication can cause minor side effects, which include: Unpleasant taste Drowsiness Headache Nasal irritation Sneezing
Eyedrops Several different mast cell stabilizer eyedrops are available by prescription. None are sold over-the-counter. Examples include: Cromolyn sodium (Crolom) Lodoxamide (Alomide) Pemirolast (Alamast) Nedocromil (Alocril)	Mast cell stabilizer eyedrops prevent the release of the symptom-triggering chemical histamine. They reduce symptoms associated with hay fever and allergic conjunctivitis.	Cromolyn sodium and lodoxamide can cause: Burning or stinging eyes Rarely, other side effects Pemirolast may cause: Chills Coughing and sneezing Sore throat Nedocromil may cause side effects including: Blurred vision Changes in color vision Breathing problems or wheezing Insomnia Eye irritation or swelling Headache Increased sensitivity of eyes to sunlight Nasal congestion

Injectable epinephrine: First aid for severe allergic reactions

If you're highly allergic to certain foods, such as peanuts, or to bee or wasp venom, you may be at risk of anaphylactic shock — a sudden, life-threatening allergic reaction. To be on the safe side, your doctor may suggest that you carry an injectable dose of epinephrine (adrenaline). Epinephrine can help slow the reaction while you seek emergency medical treatment. You may be able to administer the drug by yourself, after being taught how to use a self-injecting syringe and needle. A friend, family member or medical professional called in response to a severe anaphylactic reaction also may administer the medication.

Work with your doctor

By understanding how allergy medications work, you can work with your doctor to develop a treatment plan that's best for you. Before taking any medication — prescription or over-the-counter — be sure to tell your doctor if you are pregnant or breast-feeding, if you have any chronic health problems such as diabetes, glaucoma or high blood pressure, or if you're taking any other medications. This will help you avoid a drug interaction or other adverse effect.

Keep track of your symptoms, when you use your medications, and how much you use — that way you and your doctor can figure out what works best. It may not be possible for you to avoid allergy symptoms altogether — but working with your doctor to find the right medications can help.