關於心臟病 你應該知道的救命指南

Tremendous progress has been made in treating heart disease, but it is still the biggest killer of Americans, accounting for one in seven deaths. Here are answers to some common questions about the symptoms and treatment of heart attacks and narrowed aortic valves.

在治療心臟疾病方面，人們已經取得了長足的進展，不過它仍然是美國最大的死亡原因，大約每七個死亡病例中，就有一人是死於心臟病。以下是關於心肌梗塞和主動脈瓣狹窄的症狀及療法的一些常見問題和解答。

How do you know if you are having a heart attack?

如何判斷自己會不會患心肌梗塞？

Most people feel pain, pressure or squeezing in their chest. What doctors call the Hollywood heart attack — a person suddenly clutches his or her chest and falls to the ground — is unusual. In addition to or instead of chest pain, about a third of people have symptoms that include abdominal pain, heavy sweating, back pain, neck pain, nausea and vomiting. Many people mistakenly dismiss such symptoms, said Dr. Mary Norine Walsh, the vice president of the American College of Cardiology.

很多人感到疼痛、壓力、胸悶，不過醫生們稱作“好萊塢心梗”的症狀——也就是一個人突然抓住胸口，頹然倒地——並不常見。大約有三分之一的人除了胸口疼之外，還會有腹痛、嚴重出汗、背痛、頸痛、噁心、嘔吐等症狀，或者只有上述症狀而並無胸口疼。許多人會錯誤地忽視這些症狀，美國心臟病學會(American College of Cardiolog)副會長瑪麗·諾林·沃爾什(Mary Norine Walsh)說。

How can you decide if symptoms other than chest pain are actually from a heart attack?

該如何斷定胸口疼之外的這些症狀，實際上來源於心梗呢？

If your symptoms come on suddenly, or if they worsen over a period of hours or days, you should assume they are caused by a heart attack and go to an emergency room.

如果症狀突如其來，或者在幾小時或幾天的時間裏加劇，就應該認爲它們是由心梗誘發的，應當去急診室求醫。

Do women have different symptoms than men?

女性的症狀會與男性不同嗎？

Probably not, but women are more likely to delay seeking help and doctors are more likely to dismiss their symptoms. That is especially true if the woman is younger, Dr. Walsh said. Women tend to on average have heart attacks about 10 years later than men, so doctors may dismiss worrisome symptoms in middle-aged women.

可能不會，不過女性推遲求助，以及醫生對她們的症狀不予理會的可能性都更高。沃爾什表示，如果女性更年輕一些尤其如此。女性患心梗的時間往往比男性平均晚大約10年，因此醫生可能會對中年女性的一些令人擔憂的症狀不予考慮。

What should you do if you are having heart attack symptoms?

如果有心梗症狀應該怎麼辦？

Call 911 for an ambulance to take you to the emergency room immediately. Do not try to drive yourself or have a friend or family member drive you. Paramedics can take an electrocardiogram on the way to the hospital that shows if you are having a heart attack and transmit it to the hospital. So as soon as you arrive, the medical staff is prepared and waiting. The paramedics can also administer oxygen and medications to ease your pain before you reach the hospital. And an ambulance is less likely to get stuck in traffic.

打急救電話，請對方立即派救護車接你去急診室。不要試圖自己開車，或是讓朋友或家人開車送你去。急救護理人員可以在去醫院的路上給你拍心電圖，並將其傳給醫院。心電圖能顯示你是不是心梗發作了。因此，你一到醫院，醫務人員就已經準備就緒，在等候了。急救護理人員還能在你到達醫院之前，給你輸氧並提供緩解疼痛的藥物。同時，救護車堵車的可能性也更小。

How can you find out if your local hospital is able to treat heart attacks quickly?

怎麼能知道當地的醫院是否有能力快速治療心肌梗塞？

Time is of the essence when you are having a heart attack, and while most hospitals today are much quicker than they were a decade ago, some are faster than others. Often, paramedics know which hospital is best and will take you there. You don’t want to waste time fighting with paramedics when you are having a heart attack. “I have had patients drive three hours to come to my hospital when they were in the middle of a heart attack because they thought they needed to come to a big medical center,” Dr. Walsh sayid. “If paramedics say, ‘We’ll get you to this hospital,’ go,” she added.

心梗發作時，時間至關重要。儘管現在大部分醫院的行動都比十年前更迅速了，但其中一些還是比其他的更勝一籌。通常，急救護理人員知道哪家醫院最好，並會把你送到那裏去。心梗發作時，你是不希望把時間浪費在和急救護理人員鬥爭上的。“我有病人心梗發作了還自己驅車三小時來我所在的醫院，因爲他們認爲自己需要來大型醫療中心，”沃爾仕說。“如果急救護理人員說，‘我們會送你去這家醫院，’那就去吧，”她接着說。

There is no national registry you can consult to find out how long it takes the hospitals in your area to open a blocked coronary artery with a balloon after your arrival at the emergency room. These statistics — known as door to balloon time — are generally measured by the hospital’s median time, which is the point at which half are opened faster, and half slower. If you want to know your hospital’s median door to balloon time, you will have to call each one and ask for it. If they do not provide it, you can ask if they take certain steps that speed treatment. Do paramedics transmit a patient’s electrocardiogram from the ambulance en route to the emergency room? Does the emergency room doctor read the EKG and send out a single call to summon the cardiology team? Are the team members on call required to be within 30 minutes of the hospital?

目前沒有全國性的登記資料供你查詢，以瞭解在到達急診室後，你所在地區的醫院要用多久才能替你打通被阻塞的冠狀動脈。這些統計數據，即從入院到血管打通的時間，一般是用醫院的中位數時間來衡量的。以這個時間爲標準，一半比它快，一半比它慢。如果想知道你要去的醫院的中位數時間，你得挨個打電話問。如果醫院拒絕提供，你可以問問它們會不會採取某些加速治療的措施。在去急診室的路上，急救護理人員會從救護車上傳輸患者的心電圖嗎？急診室的醫生會讀取心電圖並用一個電話就叫來心臟病醫療團隊嗎？待命的團隊成員會被要求在30分鐘之內趕到醫院嗎？

What are the symptoms of a severely narrowed aortic valve?

主動脈瓣嚴重狹窄有什麼症狀？

Cardiologists say there are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting. Such symptoms are often mistakenly attributed the normal process of slowing down that comes with old age. Six months ago, an 85-year-old woman might have been driving a car and doing her own grocery shopping, said Dr. Michael Mack of Baylor Health Care System. Now she is doing none of those things. Her children notice but say: “Well, she’s 85. What do you expect?” If a doctor is consulted, he or she may chalk it up to anemia or a thyroid problem. Many older adults with severe aortic valve disease are never diagnosed, said Dr. Howard Herrmann of the University of Pennsylvania.

心臟病醫生表示，這種老年病有三種典型症狀：呼吸急促、感到胸悶胸口疼、昏厥。這種症狀往往會被錯誤地歸咎於伴隨衰老而來的正常的行動遲緩。六個月前，一個85歲的老太太可能還自己開車去採購食品雜貨，拜勒醫療保健系統(Baylor Health Care System)的邁克爾·麥克(Michael Mack)說。現在，這些事情她一樣都做不了。她的孩子注意到了，但會說：“畢竟她都85了，還能指望什麼？”如果諮詢醫生，可能會把這歸結於貧血或甲狀腺問題。賓夕法尼亞大學(University of Pennsylvania)的霍華德·赫爾曼(Howard Herrmann)說，很多患有嚴重的主動脈瓣疾病的老年人從未被診斷出來。

How can a doctor know if symptoms are caused by a narrowed aortic valve?

醫生怎麼知道症狀是不是主動脈瓣狹窄造成的？

The doctor can hear a heart murmur in the patient’s chest. An echocardiogram can reveal the narrowed artery and the extent of the damage.

醫生能聽到患者的心臟雜音。超聲心動圖能顯示動脈變窄，以及受損的程度。

Should everyone with a severely narrowed artery have it replaced?

所有主動脈瓣嚴重狹窄的人都應該更換主動脈瓣嗎？

Now that there is a procedure, transcatheter aortic valve replacement, or TAVR, that allows doctors to replace valves without doing open-heart surgery, high risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement. But, Dr. Herrmann cautioned, some patients are still too frail to benefit or have another disease like cancer or dementia that limits life expectancy.

有一種手術叫經導管主動脈瓣置換術（transcatheter aortic valve replacement，簡稱TAVR），能讓醫生不做開胸手術就置換掉瓣膜。這樣，被認爲可能死於開胸手術的高危患者，就有換瓣膜的機會了。但赫爾曼告誡，一些患者還是會因爲太過虛弱，而無法從這種手術中獲益，也可能同時患有癌症或失智等其他縮短預期壽命的疾病。