Antihistamines
Histamine is an important body chemical that (or this, whichever) is responsible for the congestion, sneezing, and runny nose that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing the allergy symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established.

The most annoying side effect that antihistamines produce is drowsiness. Though desirable at bedtime, it is a nuisance to many people who need to use antihistamines in the daytime. To some people, it is even hazardous. These drugs are not recommended for daytime use for people who may be driving an automobile or operating equipment that maybe could be dangerous. Newer non-sedating antihistamines, available by prescription only, do not have this effect. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome.

Typical antihistamines include Allegra®, Benadryl®, Chlor-Trimetron,®, Claritin®, Clarinex®, Teldrin®, Zyrtec,® etc.

Nose Sprays
The types of nose sprays that can be purchased without a prescription usually contain decongestants for direct application to nasal membranes. They can give prompt relief from congestion by constricting blood vessels. However, direct application creates a stronger stimulation than decongestants taken by mouth. It also impairs the circulation in the nose, which after a few hours, stimulates the vessels to expand to improve the blood flow again. This results in a "bounce-back" effect. The congestion recurs. If the patient uses the spray again, it starts the cycle again. Spray–decongestion– rebound–and more congestion.

In infants, this rebound rhinitis can develop in two days, whereas in adults, it often takes several more days to become established. An infant taken off the drops for 12 to 24 hours is cured, but well-established cases in adults often require more than a simple "cold turkey" withdrawal. They need decongestants by mouth, sometimes corticosteroids, and possibly (in patients who continuously have used the sprays for months and years) a surgical procedure to the inside of the nose. For this reason, the labels on these types of nose sprays contain the warning "Do not use this product for more than three days." Nose sprays should be reserved for emergency and short term use.

Decongestants, on the other hand, cause constriction or tightening of the blood vessels in those membranes, which then forces much of the blood out of the membranes so that they shrink, and the air passages open up again.

Decongestants are chemically related to adrenalin, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants is a jittery or nervous feeling. They can cause difficulty in going to sleep, and they can elevate blood pressure and pulse rate. Decongestants should not be used by a patient who has an irregular heart rhythm (pulse), high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants are phenylephrine (Neo-Synephrine®*), and pseudoephedrine (Sudafed®, etc.)

* May be available over–the–counter without a prescription. Read labels carefully, and use only as directed.

Combination Remedies
Theoretically, if the side effects could be properly balanced, the sleepiness sometimes caused by antihistamines could be cancelled by the stimulation of decongestants. Numerous combinations of antihistamines with decongestants are available: Actifed,®* Allegra-D,® Chlor-Trimeton D,®* Claritin D,® Contac,®* Co-Pyronil 2,®* Deconamine,® Demazin,®* Dimetapp,®* Drixoral,®* Isoclor,®* Nolamine,® Novafed A,® Ornade,® Sudafed Plus,® Tavist D,®* Triaminic,®* and Trinalin,® to name just a few.

A patient may find one preparation quite helpful for several months or years but may need to switch to another one when the first loses its effectiveness. Since no one reacts exactly the same as another to the side effects of these drugs, a patient may wish to try his own ideas on adjusting the dosages. One might take the antihistamine only at night and take the decongestant alone in the daytime. Or take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use.

Patients with coronary artery blockages may have minimal symptoms and an unremarkable or unchanged EKG while at rest. However, symptoms and signs of heart disease may become unmasked by exposing the heart to the stress of exercise. During exercise, healthy coronary arteries dilate (develop a more open channel) than an artery that has a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to it's area of distribution. This reduced flow causes the involved muscle to "starve" during exercise. The "starvation" may produce symptoms (like chest discomfort or inappropriate shortness of breath), and the EKG may produce characteristic abnormalities. Most commonly, a motorized treadmill is used for exercise, while a stationary bicycle is used in some exercise laboratories. When is a Regular Stress Test ordered? A regular stress test is considered in the following circumstances:

Patients with symptoms or signs that are suggestive of coronary artery diseases (CAD). Patients with significant risk factors for CAD.

To evaluate exercise tolerance when patients have unexplained fatigue and shortness of breath.

To evaluate blood pressure response to exercise in patients with borderline hypertension.

To look for exercise-induced serious irregular heart beats. Please remember that the regular stress test is heavily dependent upon interpretation of EKG changes produced by exercise.

The patient is brought to the exercise laboratory where the heart rate and blood pressure are recorded at rest. Sticky electrodes are attached to the chest, shoulders and hips and connected to the EKG portion of the Stress test machine. A 12-lead EKG is recorded on paper. Each lead of the EKG represents a different portion of the heart, with adjacent leads representing a single wall. For example:

Leads 2, 3, and aVF = bottom or inferior portion of the heart.

Leads V1 and V2 = septum or partition of the heart.

Leads V3, V4, V5 and V6 = anterior or front portion of the heart. Leads 1 and aVL = superior or top and outer left portion of the heart.

Lead aVR looks at the cavity of the heart and has almost no clinical value in identifying coronary disease.

Three of the EKG leads are also constantly displayed on the treadmill monitor. Each lead representing a different wall. The physician has the option of selecting different combinations of three.

The treadmill is then started at a relatively slow "warm-up" speed. The treadmill speed and it's slope or inclination are increased every three minutes according to a preprogrammed protocol (Bruce is the commonest protocol in the USA, but several other protocols are perfectly acceptable). The protocol dictates the precise speed and slope. Each three minute interval is known as a Stage (Stage 1, Stage 2, Stage 3, etc. Thus a patient completing Stage 3 has exercised for 3 x 3 = 9 minutes). The patient's blood pressure is usually recorded during the second minute of each Stage. However, it may be recorded more frequently if the readings are too high or too low. As noted earlier, the EKG is constantly displayed on the monitor. It is also recorded on paper at one minute intervals. The physician pays particular attention to the heart rate, blood pressure, changes in the EKG pattern, irregular heart rhythm, and the patient's appearance and symptoms. The treadmill is stopped when the patient achieves a target heart rate (this is 85% of the maximal heart rate predicted for the patient's age).

However, if the patient is doing extremely well at peak exercise, the treadmill test may be continued further. The test may be stopped prior to achievement of the target heart rate if the patient develops significant chest discomfort, shortness of breath, dizziness, unsteady gait, etc., or if the EKG shows alarming changes or serious irregular heart beats. It may also be stopped if the blood pressure (BP) rises or falls beyond acceptable limits. Please note that the systolic BP (upper number) may normally rise to 200 at peak exercise. At the same time, the diastolic BP (lower number) remains unchanged or falls to a slight degree. In contrast, the BP of patients with hypertension or high BP will show a rise of both systolic and diastolic readings. The latter may rise above 90 - 100.

Preparing for the Regular Stress Test:

The following recommendations are "generic" for all types of cardiac stress tests: Do not eat or drink for three hours prior to the procedure. This reduces the likelihood of nausea that may accompany strenuous exercise after a heavy meal. Diabetics, particularly those who use insulin, will need special instructions from the physician's office. Specific heart medicines may need to be stopped one or two days prior to the test. Such instructions are generally provided when the test is scheduled. Wear comfortable clothing and shoes that are suitable for exercise. An explanation of the test is provided and the patient is asked to sign a consent form. How long does the entire test take? A patient should allow approximately one hour for the entire test, including the preparation.