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View Full Version : Characters with heart trouble....health expert needed.



Hip-Hop-a-potamus
12-16-2009, 05:12 PM
So back in the day, when you had characters with heart trouble, you always saw them reaching for their nitroglycerin pills, then you had the baddies kicking the pills away so they'd expire without them.

I know nowadays, aspirin is being hawked-- that you can take an aspirin to ward off a heart attack since it thins the blood. I'm not sure that's what I want though.

In this modern day, if my character has high blood pressure and heart trouble, what will they most likely be taking, and what would they reach for at the first sign of a heart attack? And will it be lethal if they don't get it in time?

BillPatt
12-16-2009, 06:02 PM
THe first thing they would reach for is a phone and call 911.

OK, that was facetious.

Nitroglycerine is still the drug of choice for angina. Of course, that means you've already had at least one episode of heart trouble to get diagnosed. Nitro helps with the pain, I don't believe it does anything to resolve the underlying problem - which is a clot blocking a coronary artery.

For that, you go for some kind of anticoagulant. Aspirin is a COX-2 inhibitor, COX-2 being one of the enzymes that is part of the clotting pathway. Once a clot is formed, though, there's not much aspirin will do to help, except keep the clot from growing.

That is why you need a clot-buster drug - something that will dissolve the fibrin strands of the clot. And those are in the emergency room.

waylander
12-16-2009, 06:51 PM
The pain of angina is due to a restricted blood supply to an area of heart muscle.
Nitroglycerine and other nitro containing compounds deliver NO which dilates the blood vessels to improve blood flow. So reaching for your nitro pills is entirely sensible.

BillPatt
12-16-2009, 07:05 PM
The pain of angina is due to a restricted blood supply to an area of heart muscle.
Nitroglycerine and other nitro containing compounds deliver NO which dilates the blood vessels to improve blood flow. So reaching for your nitro pills is entirely sensible.

What do I know...I will probably be the kind of guy that drops like a steer one day in this damn cube farm....at least the wife will get the double indemnity company life insurance that way.

Hip-Hop-a-potamus
12-16-2009, 07:25 PM
Thanks, ya'll.

Bill you're a smarty pants. I like your posts. :D

Just make sure your wife doesn't have a guy named Walter Neff on the side and you should be fine.

I actually DO need to find out who my gal would call in an emergency. I'm out here in the Alberta bush, and I need to figure out the 911 issue too. I'll find that out from the locals.

Collectonian
12-16-2009, 08:03 PM
For my most recent novel, I had to do some research on heart issues as well (in my character's case, she has bad heart damage and lung damage). From what I read on various medical sites and talking with my mom (retired nurse), yes, nitroglycerine is still the choice of what to grab during a mild attack or flare up of pain. Its slipped under the tongue, and the patient is supposed to sit very still a few minutes until it takes affect. Make sure to check the side affects, as well, as I found that most stories that have characters needing them neglect to mention that they frequently cause head splitting headaches and other side affects. (And my baddie flips them over his shoulder after taunting, though as he planned to kill her anyway, they wouldn't have helped :-P)

For high blood pressure and heart problems, they will also be on a variety of prescription drugs to take regularly. I made some notes on them but am at my office at the moment and they are on the home comp. Mine has some fairly bad stuff, so she takes over a dozen pills a day. When I get home I can post the list of drugs I have mine on, if you'd like some starting points. Depending on your character, they may not need as many.

Be curious to see what Canada's "911" equivalent is. My novel is set in Japan, so at one point a character called 119 :-D

Hip-Hop-a-potamus
12-16-2009, 08:25 PM
For my most recent novel, I had to do some research on heart issues as well (in my character's case, she has bad heart damage and lung damage). From what I read on various medical sites and talking with my mom (retired nurse), yes, nitroglycerine is still the choice of what to grab during a mild attack or flare up of pain. Its slipped under the tongue, and the patient is supposed to sit very still a few minutes until it takes affect. Make sure to check the side affects, as well, as I found that most stories that have characters needing them neglect to mention that they frequently cause head splitting headaches and other side affects. (And my baddie flips them over his shoulder after taunting, though as he planned to kill her anyway, they wouldn't have helped :-P)

For high blood pressure and heart problems, they will also be on a variety of prescription drugs to take regularly. I made some notes on them but am at my office at the moment and they are on the home comp. Mine has some fairly bad stuff, so she takes over a dozen pills a day. When I get home I can post the list of drugs I have mine on, if you'd like some starting points. Depending on your character, they may not need as many.

Be curious to see what Canada's "911" equivalent is. My novel is set in Japan, so at one point a character called 119 :-D

That would be great! I would be interested to see the list, as I haven't fully fleshed out the person needing the drugs. Could be some of the ailments are the same.

Aggie, eh? Or just hanging out in BCS for fun? :)

BillPatt
12-16-2009, 08:26 PM
I wonder if 119 would work in Isreal....Hebrew is read right to left...As is Japanese, I think. Or was that Chinese?

In one episode of House, MD, he injects himself with Nitro to instill a migraine headache. First or second season, I believe.

Then there's Amyl Nitrite. It does the same thing as Nitroglycerine, but supposedly has a fun side as well. From my friend, Wikipedia:


Amyl nitrite, in common with other alkyl nitrites,[3] is a potent vasodilator, i.e., it expands blood vessels, resulting in lowering of the blood pressure. Alkyl nitrites function as a source of nitric oxide, which signals for relaxation of the involuntary muscles. Physical effects include decrease in blood pressure, headache, flushing of the face, increased heart rate, dizziness, and relaxation of involuntary muscles, especially the blood vessel walls and the anal sphincter. There are no withdrawal symptoms. Overdose symptoms include nausea, emesis (vomiting), hypotension, hypoventilation, dyspnea (shortness of breath), and syncope (fainting). The effects set in very quickly, typically within a few seconds and disappearing soon after (within a minute).

Of course, that explains my high school days. I must have had some kind of AM generator, cuz I would suffer all of the side effects listed (except for that sphincter thingy, and fainting) It's better now that I've been beaten down with marriage for 25 years.

Hip-Hop-a-potamus
12-16-2009, 08:40 PM
I wonder if 119 would work in Isreal....Hebrew is read right to left...As is Japanese, I think. Or was that Chinese?

In one episode of House, MD, he injects himself with Nitro to instill a migraine headache. First or second season, I believe.

Then there's Amyl Nitrite. It does the same thing as Nitroglycerine, but supposedly has a fun side as well. From my friend, Wikipedia:



Of course, that explains my high school days. I must have had some kind of AM generator, cuz I would suffer all of the side effects listed (except for that sphincter thingy, and fainting) It's better now that I've been beaten down with marriage for 25 years.

Isn't amyl nitrate what they used to call "poppers" back in the day? The club drug? I would not know this but for the fact that I read "And the Band Played On" back in the day.

My 80s club days were just a side effect of working in a record store with lots of freebies and backstage passes and such. More booze than anything else.

Collectonian
12-16-2009, 08:46 PM
Aggie, eh? Or just hanging out in BCS for fun? :)

Nope, far from being an Aggie. Moved here 10 years ago, though, and love the area despite the students, and will probably stick around most of my life :-)

Hip-Hop-a-potamus
12-16-2009, 09:12 PM
Nope, far from being an Aggie. Moved here 10 years ago, though, and love the area despite the students, and will probably stick around most of my life :-)

I'm SO homesick. Whenever I start getting like this, I have to put on some Joe Ely music and dream of Chuy's enchiladas verdes to help me cope.

Collectonian
12-16-2009, 09:29 PM
I don't know...after reading the Aggie author meltdown over on Amazon, I'm tempted to modify my profile and pretend I'm from Houston for awhile :-P

Hip-Hop-a-potamus
12-16-2009, 10:35 PM
I don't know...after reading the Aggie author meltdown over on Amazon, I'm tempted to modify my profile and pretend I'm from Houston for awhile :-P

Link please... I missed it!-- Never mind. Found it!

Collectonian
12-17-2009, 03:49 AM
Home :-) Okay, my character takes:

* an ACE inhibitor, 3 times a day, two hours after meals or one hour before - helps lower blood pressure and the volume of blood in the bod, easing the heart's job
* a beta-blocker (Carvedilol), 2 times a day with food - reduces heart's attempts to beat faster to make up for not working as well; also helps lower blood pressure
* digoxin, one a day, two hours after or one hour before meals - makes heart contractions stronger, and prevents ventricles from beating too fast
* a diuretic (spironolactone), 3 times a day with or without food - helps remove sodium and water from the blood, and reduce overall fluid build up
* nitroglycerin – for attacks

http://www.americanheart.org/presenter.jhtml?identifier=118 is one of several sites I found some good info on the basics of dealing with various kinds of heart disease

For nitro, in addition to what I noted above about sitting still, one can actually take up to 3 pills, faced a few minutes apart, for heart pain before calling an ambulance, depending on their condition and the pain

Hope it helps :)

Chasing the Horizon
12-17-2009, 08:26 AM
Not everyone with a heart condition takes a lot of medication. My mom has a heart condition which causes occasional angina, but hers is on the less severe end of the spectrum and the only med she takes other than nitro is lisinopril (I think that's what it's called) to keep her blood pressure down.

Also, one thing not mentioned about nitro is that it has a really short shelf life (like 2 months, I think), so if you don't have to use it very often, like my mom, it can expire and not be very effective when you do need it. That stuff is a pain in the ass, actually.

Collectonian
12-17-2009, 11:38 AM
True on the short shelf life. Mine gets a refill midway through the book :-D Drugs needed will depend on the condition. I used congenital heart failure treatments in deciding what my MC takes, as I needed her to have a seriously bad condition that is slated to kill her. :-)

Hip-Hop-a-potamus
12-18-2009, 06:14 PM
Thanks, Coll. Love the list.

Chase-- I need to have the character be on medication that will necessitate constant and regular taking, and if missed, could be a problem. Like if the person is having an attack and daughter-in-law refuses to hand her/him the medication.

My MC is going to be a bit unhinged from living in the woods with her in-laws and being driven slowly crazy by them (OK, OK, yeah. The characters will be BASED on fact, but I would never CONSIDER hurting them. Except when MIL starts banging dishes around again. Or makes sauerkraut AGAIN and pollutes the entire house with that godawful smell, or ....).

MC is going to be a bit more...shall we say....sociopathic than me.

BillTrain
12-19-2009, 06:42 AM
Hi,
911 in Canada is 911.
Your character is only likely to be on Digoxin and spironolactone if he has bad heart failure, not just a run-of-the-mill heart problem. Nitro (spray usually) is used for heart pain/angina...but not getting it wouldn't make your character keel over. Unless he was having a heart attack that was going to make him keel over anyway, and he was reaching for his nitro out of habit. Withholding the nitro wouldn't kill him, but it might be kind of mean. BillPatt's right, your MC needs an ambulance.
Cheers,
BT

JrFFKacy
12-19-2009, 07:44 AM
I've been paged to a medical assist involving the same male twice. Both times he was having chest pain, reached for his nitro inhaeler and got a little carried away with it. We then get call involving unconcious male patient, respond to scene, load him onto the ambulance and send him off to ER. Can't remember whether he came concious while Fire was with him on either occasion.

So too much nitro is a bad thing. Though I guess that's true for all drugs.