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 Post subject: Living with angina
 Post Posted: Thu May 05, 2005 3:40 am 
Living with angina

by Dr. D. P. Atukorale
@ The Island 05 AMY2005


Angina a 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 ‘Vincent’s anginal 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, this 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 constricting 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 Or 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 all 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 Comes 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 ha’s 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).

Proper Use of Rest

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.

Smoking.

Undoubtedly cigarette smoking keeps up the ten dendency to attacks of an gin a 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 Glycerol 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 Lank 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 (aublingual) or if you can afford, GTN spray.

Sometimes it does happen that the angina patient can I 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 drug increase as research progresses, Your family physician or your cardiologist will know all about these and will preseribe the one which is moat suitable for you personally and all these druge, 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.

Sexual intercourse which is painful or causes distress instead of pleasure may bring on an attack of angina, Unnecessary feats of activity such as moving the piano or opening a window which has become stiff or digging in the garden for too long or transporting a gas cylinder into the kitchen can precipitate an attack of angina.

Stress And Angina

There are mental causes which bring on angina. A violent TV program or a horror film -can produce the sort of fear situation that causes an attack. Strain, shock) fear about the family can induce an attack: of angina in a heart patient.

If angina comes on when you are walking, you will soon rind the pace at which you can walk comfortably or it is advisable for you to take a GTN tablet before you start walking. Many angina patients develop a new scheme of organizing their lives, they arrange to avoid the excessive efforts, as for instance, by walking one way and taking the bus back. It is preferable for an gin a patient to have a room down stairs.

Management of time is a difficult chore, Some of us work against the clock and this causes a strain on your circulation. A housewife must try to cut out unnecessary jobs, transfer some of the others to the family and gently tackle the rest herself. She should if possible put up her feet whenever possible, relaxing, with a cup of tea, reading a book or switching on a TV program or closing the eyes and meditating for a few minutes.

Obesity (Over weight)

Overweight is one, of the most serious forms of overstrain on heart and circulation. The heart has to, do more, the blood vessels have to work harder to keep the same quantity of blood circulating over a larger volume of muscle and fat,. If you are 10 percent overweight, then every moment of the day and night your heart has to do 10 percent more work than it was designed to do. Don’t try to reduce your weight too quickly, If you can bring it down to near normal within 2 to 4 months, this will be quite, satisfactory and only the first week or two will be really hard. Keep a record of your weight and this will encourage you.

There are many systems of diet.. Rice, bread, cakes, sugar) yams, fate, beer and spinta are the worst enemies of the, person trying to lose weight. Always e at moderately especially before going to bed. A short walk after dinner is very healthy. Try to rest for 10-15 minutes or longer after each meal especially after lunch and dinner, Don’t eat or drink anything you know will disagree with you even if this means offending the cook or hostess as a digestive upset or flatulence can bring on an attack of angina. Too much alcohol is bad for an angina patient.

Emotional Stress

It is hard for any of us ‘control, our temperament. Anger, excitement, fear and tension all start the heart racing and if you are "highly strung type you should try to build up a discipline which will make you take life tolerantly, This requires distinct effort, You should accept calmly those pin .,pricks which come to all of Us.

Do not brood about people you dislike or you are sure have wronged you. Merely keep out of their way, Keep clean of people -and situations which make you lose your temper. Switch off over — exciting TV programmes and scenes of violence.

Motor Driving

You should do your uttermost to rearrange your routes to avoid traffic jams as traffic jams precipitate angina in coronary patients, Fast driving is a form of stress which should be avoided, Weekend driving for relaxation and pleasure can be wonderful

Exercise for the Angina Patient

The safest exercise is walking not necessarily quick walking or sprinting but walking at a leisure pace — two to three kilometres in I the open air in as pleasant surroundings, as possible. Swimming too is good- provided you do not overtax yourself and the water, is not too cold. Do ‘not be tempted into competitive games,

Most people who are no longer young get broken nights. A. Sundaynap will help you. It is advisable for heart patients to rest for about 15 to 20 minutes after lunch. Although sleeplessness is disagreeable for you as a heart patient, just lying in bed horizontally will be beneficial even when you are not asleep. Give yourself 8 or more hours in bed.

Holidays

Everyone is the better for a holiday that gives a real change of surroundings and activities. A holiday during which there is no pressure on you seems to endow you with increased energy. When you are holidaying, don’t drive your car like a madman after drinking beer or arrack. Let your holiday be restful in the open air and sunshine with congenial people.

Look upon your angina as a friendly warning signal that your circulation is in distress, and for your good, you should immediately stop all activity for a short time. You must get an early appointment too see your G.P., who, I am sure will arrange for few tests like E.C.G., blood sugar and blood cholesterol after doing a good general examination. If necessary your OR will refer you to a cardiologist for tests such as exercise ECO, 2D-Echocardiogram and coronary angiography if above tests are necessary.


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