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你会不会心脏病发作而不自知?

更新时间:2017-10-17 11:41:52 来源:纽约时报中文网 作者:佚名

Can you have a heart attack and not realise it
你会不会心脏病发作而不自知?

The classic description of the sensation of a heart attack is that it’s like a heavy weight crushing your chest accompanied by a feeling of overwhelming anxiety. In films people clutch their chests, show panic in their eyes and then fall to the floor. And it can happen just like that. But not always.

长期以来,人们一直把心肌梗塞比喻成像是有一个重物敲击你的胸部,同时伴随着巨大的焦虑感。电影里,突发心脏病的人会紧紧捂住胸口,眼光中充满惊恐,然后瘫倒在地上。有些心肌梗塞病例的发作表现的确如此,但不是全部。

Heart attacks occur when the supply of blood to the heart becomes blocked, usually by a blood clot. Despite what’s happening in the body, sometime people feel no chest pain at all, which means they delay getting help. Even with mild chest pain, many assume they have indigestion and only discover later that they’ve had a heart attack after an electrocardiogram in hospital shows damage to the heart. Sometimes this is known as a silent heart attack. A study published in 2016 found this could happen in as many as 45% of heart attacks.

当心脏供血由于血栓而遭到堵塞时即会出现心肌梗塞。然而在某些情况下,尽管此时体内出现了病症反应,病人却对此一无所知,从而使他们无法及时得到救治。很多人即便出现中等强度的胸痛,也会认为仅仅是消化不良,但随后却在医院心电图测试中发现实际上是心肌梗塞在作祟。有人将这种情况称为"沉默"心肌梗塞。2016年发表的一篇论文指出,这种情况占心肌梗塞总病例数的45%之多。

The data for this research started being collected in the late 1990s and since then the diagnosis of heart attacks has improved, so the figure would probably not be as high today, but every year there are still some people who, at the time, had no idea they were having a heart attack.

这项研究早在1990年代初就开始收集数据。当时的心肌梗塞诊断技术还没有今天的先进,因此当时可能有误诊情况。但当时仍然存在病人对自己的心肌梗塞毫不知情的现象。

There are also patients who knew that they were ill, but not why. They feel pain in the jaw, neck, arms, stomach or back and feel short of breath, weak or light-headed. They might sweat or vomit. It’s the combination of symptoms rather than the severity of chest pain that allows for a diagnosis.

还有病人知道自己身体有病,但不知道是什么病。他们感觉下颚、颈部、手臂、腹部或背部疼痛,气短、体虚、眩晕、出汗或呕吐。他们去医院检查诊断的原因是出现了上述症状的组合,而非感受到严重胸痛。

It is often said that these heart attacks without chest pain are more common in women, leading women to delay getting help and reducing their chances of survival. In order to establish whether this really is the case, researchers in Canada in 2009 set out to measure the symptoms of a heart attack systematically, by studying 305 patients undergoing angioplasty. This is where a blocked blood vessel is re-opened by inflating a small balloon inside it. The procedure can briefly mimic the symptoms of a heart attack, so while the balloons were inflated patients were asked to describe what they could feel. They found no differences between men and women in terms of chest discomfort, arm pain, shortness of breath, sweating or nausea, but women were more likely to have pain in the neck and jaw in addition to chest pain.

无胸痛症状的心肌梗塞更常见于女性,从而延误了其求救时机,降低了生存几率。为了彻底搞清其中的规律,加拿大研究人员于2009年针对305位接受血管成形术的患者开展了系统性心肌梗塞症状研究。血管成形术中,需将小气球植入血管内部,充气后即可把堵塞的血管重新撑开。手术中,当气球充气时即会模仿心肌梗塞发作时的症状。研究人员在气球充气请患者描述自我感受,发现男性和女性患者在胸部不适、手臂疼痛、气短、出汗或恶心呕吐等症状上没有区别,但是女性患者更容易感受到颈部、下颚和胸部疼痛。

The findings of other studies have been inconsistent, sometimes finding that men and women are equally likely to experience chest pain, others that it’s more common in men. Sometimes the issue is confused by researchers including other diagnoses alongside heart attacks in the same study. So in 2011 a review was conducted, with the sole aim of establishing whether there is a difference in the symptoms experienced by men and women.

其他研究的发现则缺乏一致性。有的研究发现男性和女性感到胸痛的概率相同,而有研究则发现男性的概率更高。而有的研究中涉及的病症不只有心肌梗塞,从而使问题更加复杂。于是,研究者于2011年开展了一项专项研究,研究唯一的目标就是调查患有心肌梗塞的男性和女性患者的症状异同。

Studies from the US, Japan, Sweden and Germany, UK and Canada were all included, the largest involving more than 900,000 people. The data was taken from the best 26 of these studies, combined and re-analysed. They concluded that women are less likely than men to present with chest pain and more likely than men to have symptoms such as fatigue, nausea, dizziness or fainting and pain in their neck, jaw or arms. With both sexes, the majority still experienced chest pain, but a third of women and almost a quarter of men had heart attacks without having any symptoms in their chest, making it hard for them to realise what’s happening to them.

专项研究在美国、日本、瑞典、德国、英国和加拿大等国进行,其中研究规模最大的国家调查了90万多人。对来自质量最高的26项研究的数据进行了汇总和再分析。研究者发现,与男性相比,女性出现胸痛症状的比例较低,但疲劳、恶心、眩晕、昏迷、颈痛、下颚痛和手臂痛的比例较高。大部分男性和女性都会出现胸痛,但有三分之一的女性和大约四分之一的男性心肌梗塞发作时没有任何症状,也根本不知道自己已经发病。

If you don’t know how serious your symptoms are, naturally you’re less likely to go for help. People wait on average between two and five hours.

患者没有症状就不会立即去寻求帮助。平均而言,患者要等待2-5小时才会去医院就诊。

A new study has sought to find about more about people’s thought processes in making what can be a life-and-death decision to go to a doctor. In-depth interviews with a small number of women who’d had heart attacks revealed that half knew something was wrong and immediately went for help. Three had vague symptoms which began as mild, but then got more intense, prompting them to the doctor. But the remaining people had no idea their symptoms were to do with their heart and didn’t tell anyone else, deciding to wait and see.

最近开展了一项研究,研究目的是了解人们在感受到多严重的症状时才会去医院就诊。对少量女性心肌梗塞患者所做深入访谈表明,只有一半人感觉不舒服后立即去医院。某些症状开始时很轻微,随着时间的推移不断恶化,从而迫使她们去医院就医。然而,另一半人并不知道这些症状与心脏相关,也没有告诉身边任何人,而是决定等等再看。

So the lesson is that a crushing chest pain is very serious and could indicate a heart attack, but so could a collection of other symptoms, therefore we need to consider the possibility of a heart attack even when it doesn’t seem quite like in the films.

每个人都应该知道,剧烈胸痛意味着严重健康问题,也是心肌梗塞来袭的前兆。但是其他症状也会提醒我们心脏出了问题。因此,当出现这些症状时,我们应当高度提防心肌梗塞的发作,尽管它们和电影里的情节大相径庭。

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