Living with Angina

by Dr. D. P. Atukorale

Angina is the shortened form of a medical term for angina pectoris which means literally, pain in the chest, although it is, in fact, a heart condition. True angina can be a serious matter and a great disability in life. On the other hand, it can be controlled by good management and drugs.

There is a condition called false angina which despite its name has nothing to do with heart disease. Similarly in Vincents angina' the word angina is used in an old fashioned way to mean an inflammation of the throat. But the one I am dealing in this article is real angina pectoris. Every angina patient will be the better for understanding something about this symptom, its cause and its possible control. The majority can teach themselves to come to terms with it and in doing so, they will make their lives easier and the doctors treatment more effective.

The first thing is to recognize angina, face it and make up one's mind to outwit his troublesome invader of man's peace.

The pain (sometimes called angina of effort) can occur in front or back of chest, or in shoulders or radiating up the neck, or down the arm, but it is always mainly a central chest pain of a crushing or constructing character, usually steady but not sharp and lasts for a few minutes. Sometimes the pain is felt only in upper abdomen (epigastrium) and is wrongly diagnosed as gastritis by some doctors and is treated with antacids.

The causes of Angina

Angina pectoris is caused by the condition of the coronary arteries which convey blood to the heart muscle to enable it to beat and sustain the circulation. These special arteries called coronary arteries are most important. Your heart goes on beating day and night for as long as you live. Other parts of the body can go to sleep when you are in bed, but the heart can never stop.

As we get older, all of us suffer to a greater or lesser degree, some hardening and narrowing of arteries (atherosclerosis). This is part of the wear and tear of life. Naturally in some people, it is worse than others and in these individuals these coronary arteries become so narrowed and inelastic that some part of the heart muscle is starved of its proper blood supply.

This causes angina pain which has been called the cry of the heart for more blood. Frequently angina is a warning symptom of a future heart attack. Severe angina (unstable angina) if not properly treated usually can lead to a heart attack (myocardial infarction).

Why Angina come on

Normally the constriction in the coronary arteries (essential cause of angina) is not severe enough to starve the heart muscle of blood provided individual is relaxed or lying down or walking at a comfortable pace. However, as effort increases, more blood will be needed by the heart muscle and therefore the angina pain will come on.

This extra load upon the heart can be increased by many kinds of strain such as running for a bus or train, dashing upwards, losing ones temper or becoming worked up about some personal problem. All these and many others put an extra load on the heart which it has to bear, in addition to its ordinary work and the result will be angina. A woman may get angina when she comes home from shopping or marketing, but not when she sets out. The difference is probably the extra weight of her basket.

Sometimes getting a letter which from handwriting one recognizes is likely to bring bad news may start off the attack. And some people react so powerfully to meeting another, that angina comes on. Again angina at night can be set off by an unwise meal just before going to bed.

Sometimes some teledramas you watch can set off some special emotions in your mind which can cause stress. Tears and laughter do not cause stress; only fear and memory of fear can cause stress and precipitate angina in a coronary patient.

In this article, I am not going to discuss the management of an angina patient by your family physician or cardiologist e.g., using drugs such as beta blockers, calcium channel blockers, nitrates and antiplatelet drugs or investigations for angina such as ECG, exercise ECG, 2D Echo, coronary angiography, Thallium scanning or procedures such as PTCA (angioplasty) stenting and coronary artery bypass surgery (CABG) as there have been a number of articles on above topics in the news journals and you may have been watching TV programmes on above topics. I am discussing how you should adjust your life if you are a case of coronary heart disease (CHD).

We advise our angina patients to rest, but very few patients know how to use rest properly. It seems so simple when one is fit and well. But the angina patient has to use every opportunity to take the strain off the circulation. When you come into the house, automatically push up your feet and remain for a short time in a comfortable position see that you get a proper amount of rest in bed at night, not necessarily asleep but in a horizontal position.

Undoubtedly cigarette smoking keeps up the tendency to attacks of angina and the smoker should make a big effort to abandon cigarettes completely. This can be done, and those who face the struggle for a week or two will undoubtedly find their angina less troublesome.

Relieving an Angina attack

Since angina is brought on by stress or effort, the first thing we have to do is to reduce the heart activity to a more comfortable level. Stop what you are doing and stand or sit still, putting your feet up if possible. Gradually the need for extra blood will diminish and as it goes, so will the pain.

Happily we have drugs such as Glyceryl trinitrate (GTN) sublingual tablets, GTN spray and Isosorbide mononitrate sublingual tablets. The latter 2 relieve an attack of angina in one or two minutes. Unfortunately some of the GTN tablets available in Sri Lanka take about 10 minutes to dissolve in your mouth. So whenever you get an attack of angina in addition to measures mentioned above, take GTN or Isordel (sublingual) or if you can afford GTN Spray.

Sometimes it does happen that the angina patient can walk off the attack. The heart seems to get a second wind and the pain which may have been quite severe, diminishes and disappears.

Angina caused by over-eating or by feeling of anger, tension or frustration (mostly subconscious) are not quite so easy to relieve.

Today we have very sound drugs such as beta-blockers, calcium channel blockers, nitrates and anti-platelet agents and the number of drugs increase as research progresses. Your family physician or your cardiologist will know all about these and will prescribe the one which is most suitable for you personally and all these drugs, should be used under your doctor's guidance. Should a persistent attack of angina comes on take a sublingual GTN, contact your family physician if he can be contacted, swallow a tablet of soluble asprin and request one of your relatives or friends to take you to the nearest hospital as soon as possible

Avoiding Angina

It is of course better to take thought about what brings on an attack of angina rather than expose yourself to the risk and then to be obliged to take the drug. Drugs are an aid to the simple methods of prevention rather than as a method in itself. Angina can be brought on by a number of stimuli physical or mental. Physical exertion may bring it on for example walking uphill or an unduly long walk for a bus or carrying a too heavy a weight can precipitate angina pain.