A recent case in eastern China has raised concerns about dental procedure safety. According to the South China Morning Post, a man surnamed Huang, underwent an extensive dental procedure on August 14 at Yongkang Deway Dental Hospital in Jinhua, Zhejiang province. The procedure involved extracting 23 teeth and inserting 12 implants in a single day using the “immediate restoration” method. Two weeks later, he suffered a sudden heart attack and died on August 28. The case was brought to light through an online post by his daughter Shu on September 2. 

Huang revealed that her father, whose age has not been disclosed, experienced persistent pain following the treatment. ”I never thought my dad would pass so quickly. He did not even get the chance to drive the new car we bought him,” stated his daughter.

In response to the incident, an official from the Yongkang Municipal Health Bureau stated on September 3 that the cause of death is still being investigated, citing the 13-day gap between the dental procedure and the man’s death. 

Three days later, a clinic staff member told SCMP ”We will not be responding to this matter now as it has been handed over to our lawyer. If there are any updates, we will issue a statement; however, the investigation is ongoing.”

According to Xiang Guolin, director of the Dental Medicine Centre at the Hospital of Universal Love in Wuhan, there are no established official guidelines for the maximum number of teeth that can be extracted in a single procedure. However, in general practice, the limit is typically considered to be around 10 teeth. 

”Extracting 23 teeth is quite a lot. It requires a clinic and dentist with sufficient qualifications and experience. It’s also essential to consider the patient’s physical capacity to handle such an extensive procedure,” he said.

Many social media users expressed shock and disbelief upon learning about the case. One person questioned the decision to extract 23 teeth in a single day, sharing their own experience of being refused by a dentist when requesting the removal of two wisdom teeth simultaneously. 

Another user wrote, ”I’m a dentist, and I never extract more than three teeth at one time unless they’re very loose. The doctor must have lost his mind. It sounds more like a human experiment than a dental procedure.”

Many media outlets incorrectly referred to the event as a “heart attack” or used the terms interchangeably.

A cardiac arrest and a heart attack are distinct yet overlapping concepts associated with the heart.

With some background in how the heart works, we can see how they differ and how they’re related.

Understanding the heart

The heart is a muscle that contracts to work as a pump. When it contracts it pushes blood – containing oxygen and nutrients – to all the tissues of our body.

For the heart muscle to work effectively as a pump, it needs to be fed its own blood supply, delivered by the coronary arteries. If these arteries are blocked, the heart muscle doesn’t get the blood it needs.

This can cause the heart muscle to become injured or die, and results in the heart not pumping properly.

Heart attack or cardiac arrest?

Simply put, a heart attack, technically known as a myocardial infarction, describes injury to, or death of, the heart muscle.

A cardiac arrest, sometimes called a sudden cardiac arrest, is when the heart stops beating, or put another way, stops working as an effective pump.

In other words, both relate to the heart not working as it should, but for different reasons. As we’ll see later, one can lead to the other.

Why do they happen? Who’s at risk?

Heart attacks typically result from blockages in the coronary arteries. Sometimes this is called coronary artery disease, but in Australia, we tend to refer to it as ischaemic heart disease.

The underlying cause in about 75% of people is a process called atherosclerosis. This is where fatty and fibrous tissue build up in the walls of the coronary arteries, forming a plaque. The plaque can block the blood vessel or, in some instances, lead to the formation of a blood clot.

Atherosclerosis is a long-term, stealthy process, with a number of risk factors that can sneak up on anyone. High blood pressure, high cholesterol, diet, diabetes, stress, and your genes have all been implicated in this plaque-building process.

Other causes of heart attacks include spasms of the coronary arteries (causing them to constrict), chest trauma, or anything else that reduces blood flow to the heart muscle.

Regardless of the cause, blocking or reducing the flow of blood through these pipes can result in the heart muscle not receiving enough oxygen and nutrients. So cells in the heart muscle can be injured or die.

But a cardiac arrest is the result of heartbeat irregularities, making it harder for the heart to pump blood effectively around the body. These heartbeat irregularities are generally due to electrical malfunctions in the heart. There are four distinct types:

• ventricular tachycardia: a rapid and abnormal heart rhythm in which the heartbeat is more than 100 beats per minute (normal adult, resting heart rate is generally 60-90 beats per minute). This fast heart rate prevents the heart from filling with blood and thus pumping adequately

• ventricular fibrillation: instead of regular beats, the heart quivers or “fibrillates”, resembling a bag of worms, resulting in an irregular heartbeat greater than 300 beats per minute

• pulseless electrical activity: arises when the heart muscle fails to generate sufficient pumping force after electrical stimulation, resulting in no pulse

• asystole: the classic flat-line heart rhythm you see in movies, indicating no electrical activity in the heart.

Cardiac arrest can arise from numerous underlying conditions, both heart-related and not, such as drowning, trauma, asphyxia, electrical shock and drug overdose. James’ cardiac arrest was attributed to a congenital heart defect, a heart condition he was born with.

But among the many causes of a cardiac arrest, ischaemic heart disease, such as a heart attack, stands out as the most common cause, accounting for 70% of all cases.

So how can a heart attack cause a cardiac arrest? You’ll remember that during a heart attack, heart muscle can be damaged or parts of it may die. This damaged or dead tissue can disrupt the heart’s ability to conduct electrical signals, increasing the risk of developing arrhythmias, possibly causing a cardiac arrest.

So while a heart attack is a common cause of cardiac arrest, a cardiac arrest generally does not cause a heart attack.

What do they look like?

Because a cardiac arrest results in the sudden loss of effective heart pumping, the most common signs and symptoms are a sudden loss of consciousness, absence of pulse or heartbeat, stopping of breathing, and pale or blue-tinged skin.

But the common signs and symptoms of a heart attack include chest pain or discomfort, which can show up in other regions of the body such as the arms, back, neck, jaw, or stomach. Also frequent are shortness of breath, nausea, light-headedness, looking pale, and sweating.

What’s the take-home message?

While both heart attack and cardiac arrest are disorders related to the heart, they differ in their mechanisms and outcomes.

A heart attack is like a blockage in the plumbing supplying water to a house. But a cardiac arrest is like an electrical malfunction in the house’s wiring.

Despite their different nature both conditions can have severe consequences and require immediate medical attention.

(Michael Todorovic, Associate Professor of Medicine, Bond University and Matthew Barton, Senior lecturer, School of Nursing and Midwifery, Griffith University)

(This article is republished from The Conversation under a Creative Commons license. Read the original article.)

Heart and a stethoscope with heartbeat (pulse) symbol in Light blue background
| Photo Credit: bernie_photo

Women’s heart disease risks, and their need to start taking preventive medications should be evaluated when they are in their 30s rather than well after menopause as is now the practice, said researchers who published a study on Saturday, August 31, 2024.

Presenting the findings at the European Society of Cardiology annual meeting in London, they said the study showed, for the first time, that simple blood tests make it possible to estimate a woman’s risk of cardiovascular disease over the next three decades.

“This is good for patients first and foremost, but it is also important information for (manufacturers of) cholesterol lowering drugs, anti-inflammatory drugs, and lipoprotein(a)lowering drugs – the implications for therapy are broad,” said study leader Paul Ridker of Brigham and Women’s Hospital in Boston.

Current guidelines “suggest to physicians that women should generally not be considered for preventive therapies until their 60s and 70s. These new data… clearly demonstrate that our guidelines need to change,” Dr. Ridker said. “We must move beyond discussions of 5 or 10 year risk.”

The 27,939 participants in the long-term Women’s Health Initiative study had blood tests between 1992 and 1995 for low density lipoprotein cholesterol (LDL-C or “bad cholesterol”), which are already a part of routine care.

They also had tests for high-sensitivity C-reactive protein (hsCRP) – a marker of blood vessel inflammation – and lipoprotein(a), a genetically determined type of fat.

Compared to risks in women with the lowest levels of each marker, risks for major cardiovascular events like heart attacks or strokes over the next 30 years were 36% higher in women with the highest levels of LDL-C, 70% higher in women with the highest levels of hsCRP, and 33% higher in those with the highest levels of lipoprotein(a).

Women in whom all three markers were in the highest range were 2.6 times more likely to have a major cardiovascular event and 3.7 times more likely to have a stroke over the next three decades, according to a report of the study in The New England Journal of Medicine published to coincide with the presentation at the meeting.

“The three biomarkers are fully independent of each other and tell us about different biologic issues each individual woman faces,” Dr. Ridker said.

“The therapies we might use in response to an elevation in each biomarker are markedly different, and physicians can now specifically target the individual person’s biologic problem.”

While drugs that lower LDL-C and hsCRP are widely available – including statins and certain pills for high blood pressure and heart failure – drugs that reduce lipoprotein(a) levels are still in development by companies, including Novartis (NOVN.S ), Amgen , Eli Lilly and London-based Silence Therapeutics.

In some cases, lifestyle changes such as exercising and quitting smoking can be helpful.

Most of the women in the study were white Americans, but the findings would likely “have even greater impact among Black and Hispanic women for whom there is even a higher prevalence of undetected and untreated inflammation,” Dr. Ridker said.

“This is a global problem,” he added. “We need universal screening for hsCRP … and for lipoprotein(a), just as we already have universal screening for cholesterol.”

If you Google the terms “constipation” and “heart attack” it’s not long before the name Elvis Presley crops up. Elvis had a longstanding history of chronic constipation and it’s believed he was straining very hard to poo, which then led to a fatal heart attack.

We don’t know what really happened to the so-called King of Rock “n” Roll back in 1977. There were likely several contributing factors to his death, and this theory is one of many.

But after this famous case researchers took a strong interest in the link between constipation and the risk of a heart attack.

This includes a recent study led by Australian researchers involving data from thousands of people.

Are constipation and heart attacks linked?

Large population studies show constipation is linked to an increased risk of heart attacks.

For example, an Australian study involved more than 540,000 people over 60 in hospital for a range of conditions. It found constipated patients had a higher risk of high blood pressure, heart attacks and strokes compared to non-constipated patients of the same age.

A Danish study of more than 900,000 people from hospitals and hospital outpatient clinics also found that people who were constipated had an increased risk of heart attacks and strokes.

It was unclear, however, if this relationship between constipation and an increased risk of heart attacks and strokes would hold true for healthy people outside hospital.

These Australian and Danish studies also did not factor in the effects of drugs used to treat high blood pressure (hypertension), which can make you constipated.

How about this new study?

The recent international study led by Monash University researchers found a connection between constipation and an increased risk of heart attacks, strokes and heart failure in a general population.

The researchers analysed data from the UK Biobank, a database of health-related information from about half a million people in the United Kingdom.

The researchers identified more than 23,000 cases of constipation and accounted for the effect of drugs to treat high blood pressure, which can lead to constipation.

People with constipation (identified through medical records or via a questionnaire) were twice as likely to have a heart attack, stroke or heart failure as those without constipation.

The researchers found a strong link between high blood pressure and constipation. Individuals with hypertension who were also constipated had a 34% increased risk of a major heart event compared to those with just hypertension.

The study only looked at the data from people of European ancestry. However, there is good reason to believe the link between constipation and heart attacks applies to other populations.

A Japanese study looked at more than 45,000 men and women in the general population. It found people passing a bowel motion once every two to three days had a higher risk of dying from heart disease compared with ones who passed at least one bowel motion a day.

How might constipation cause a heart attack?

Chronic constipation can lead to straining when passing a stool. This can result in laboured breathing and can lead to a rise in blood pressure.

In one Japanese study including ten elderly people, blood pressure was high just before passing a bowel motion and continued to rise during the bowel motion. This increase in blood pressure lasted for an hour afterwards, a pattern not seen in younger Japanese people.

One theory is that older people have stiffer blood vessels due to atherosclerosis (thickening or hardening of the arteries caused by a build-up of plaque) and other age-related changes. So their high blood pressure can persist for some time after straining. But the blood pressure of younger people returns quickly to normal as they have more elastic blood vessels.

As blood pressure rises, the risk of heart disease increases. The risk of developing heart disease doubles when systolic blood pressure (the top number in your blood pressure reading) rises permanently by 20 mmHg (millimetres of mercury, a standard measure of blood pressure).

The systolic blood pressure rise with straining in passing a stool has been reported to be as high as 70 mmgHg. This rise is only temporary but with persistent straining in chronic constipation this could lead to an increased risk of heart attacks.

Some people with chronic constipation may have an impaired function of their vagus nerve, which controls various bodily functions, including digestion, heart rate and breathing.

This impaired function can result in abnormalities of heart rate and over-activation of the flight-fight response. This can, in turn, lead to elevated blood pressure.

Another intriguing avenue of research examines the imbalance in gut bacteria in people with constipation.

This imbalance, known as dysbiosis, can result in microbes and other substances leaking through the gut barrier into the bloodstream and triggering an immune response. This, in turn, can lead to low-grade inflammation in the blood circulation and arteries becoming stiffer, increasing the risk of a heart attack.

This latest study also explored genetic links between constipation and heart disease. The researchers found shared genetic factors that underlie both constipation and heart disease.

What can we do about this?

Constipation affects around 19% of the global population aged 60 and older. So there is a substantial portion of the population at an increased risk of heart disease due to their bowel health.

Managing chronic constipation through dietary changes (particularly increased dietary fibre), increased physical activity, ensuring adequate hydration and using medications, if necessary, are all important ways to help improve bowel function and reduce the risk of heart disease.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Panic ensued at a casino in Singapore after a man suffered a heart attack while celebrating his 3.2 million pound (Rs 33,76,45,600) jackpot. According to news.com.au, the incident happened at the Marina Bay Sands Casino in Singapore on June 22. The unnamed man, a regular visitor to the casino, was left overjoyed after he won the life-changing amount. As he was celebrating and punching the air in sheer joy., he suddenly fell to the ground having a cardiac arrest. 

As he collapsed, horrified bystanders gathered around him as the staff rushed to help him. A woman accompanying the man became increasingly worried and was heard pleading with the staff as they tried to administer medical assistance. He was quickly rushed to the hospital where he is recovering from cardiac arrest.

Meanwhile, many social media reports suggested the man died, however, industry insiders said that the man is alive and still in recovery at the hospital. 

A spokesperson for the casino condemned the false reporting, highlighting the distress it has caused the man’s family. ”Unfortunately, the fake news has spread, and the video still circulating online is causing some distress to the guest’s family,” he said. Some sources have also disputed the amount that the gambler won, however, there is no official clarification of it yet. 

The casino is owned and operated by Las Vegas Sands, a Nevada-based company pulling revenues of $10.4 billion last year.

In a similar incident in 2021, a man in Michigan in the US was found washed up dead on a beach with the winning ticket in his pocket. A similar unfortunate incident happened in the US in April after a man fell into cardiac arrest while sitting at a Las Vegas blackjack table.