Angina Pectoris

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What is angina pectoris?

Angina pectoris is the medical term for chest pains, more specifically pains emanating from, and involving, the heart. It is most common for people to associate chest pains with impending or insipient heart attack. The same is true within the medical community: chest pains, especially by the breastbone, are considered angina pectoris till proven otherwise.

Why do physicians think this way?

Since heart attack is treacherous, serious and potentially fatal, it is safer for the patient for the attending doctor to put this condition at the top of the list of his probable diagnoses when dealing with a person with chest pains. The physician's high index of suspicion is most essential for patient safety and effective health management. In 1997, the cost of treating heart disease in the United States was a staggering sum of 58 billion dollars, followed by expenditures for cancer and trauma.

What are the other causes of chest pains?

There are a variety of other causes of chest pains. Some of them are: a pinched nerve in the neck, viral inflammation of the rib and cartilage, diseases of the ribs, the lungs (pneumonia, other infections, cancer, etc) and their covering (pleurisy and cancer), diseases of the breathing pipe, diseases of the esophagus (foodpipe), chest muscle spasm, muscle contusion or injury, arthritis of the spine or almost any joints in the chest area, diseases of the diaphragm (muscular "tent" that divides the chest cavity from the abdominal cavity into 2 separate airtight compartments), and referred pains from intra abdominal pathology.

What is the cause of angina pectoris?

Just like any muscle in the body, the myocardium (heart muscles) need oxygen and nutrition in order to "feel" comfortable, remain healthy and function well. The oxygen and nutrition are carried by blood that is circulating inside the arteries that supply all muscles, other tissues and organs throughout the body. If any of these arteries are blocked for any reason, the blood supply to the intended areas is diminished or totally cut off. The heart muscles are supplied by the coronary arteries. If these coronary arteries are blocked, the heart muscles are deprived of blood, and therefore of oxygen and nutrition, and these muscles suffer from "asphyxiation" (choking from lack of oxygen) and go into severe spasm, causing the angina pectoris.

How are these arteries blocked?

Blockages in the arteries in our body is caused by arteriosclerosis (hardening of the arteries) brought on, and/or aggravated, by several health risk factors. The main culprit ingredient is cholesterol, which mostly come from saturated fats that we eat, like red meats (pork, beef, etc.), eggs, butter, lard, dairy products, etc. Ingestion of these foods leads to high level of the bad cholesterol, which thickens the blood consistency, which leads to thick cholesterol "paint" deposits on the inside walls of the tiny coronary arteries, which are only 1 to 3 millimeters in diameter, like the size of a round toothpick. This situation is like using thick paint applied layers after layers, every second, day after day, year after year, onto the inner walls of these tiny pipes. Just like the sewer or drain pipes in our homes, this cholesterol "junk" could clog up our coronary arteries, as small as they are.

So, the thicker our blood is, the worse for us?

In essence, and simplistically put, yes. The body maintains a normal consistency of our blood, not too thick to cause clots, and not too thin to cause spontaneous bleeding. Our body does that normally as a natural inherent protective mechanism. Any one or a combination of any of the following risk factors can upset this healthy natural balance, causing blood to thicken which leads to arteriosclerosis and cholesterol blockages: smoking, ingestion of the high cholesterol foods we listed above, sedentary life (absence or lack of daily exercise), presence of diabetes and/or hypertension (high blood pressure), aging, stress, worry, fear, and to some extent, heredity or genetic predisposition.

When does a heart attack occur?

Myocardial Infarction (Heart Attack) occurs when the heart muscles are deprived of the amount of blood they need to maintain normal tissue oxygenation and nutrition. Since this blood supply to the heart muscles is provided by the coronary arteries, heart attack will result when the coronary arteries are severely blocked due to the reasons and causes explained above. Since muscles are nothing but flesh or meat, they rot or decay when blood supply is cut off for more than a few minutes, resulting in muscle damage.

How do we minimize these risk factors?

The most effective way to minimize these risk factors is by living a healthy life style, which includes the following: (1) abstinence from tobacco; (2) eating fish, vegetables and fruits (high fiber foods); (3) staying away from eggs and red meat (pork, beef and anything made of them), fried foods, lard, butter, excessive dairy products; (4) excess alcohol is poison but drinking a glass or two of red wine with meals is good for the heart so long as your physician does not find any contraindication in your case; (5) doing daily exercises (walking, ballroom dancing, etc); (6) vitamin E and aspirin as prescribed by your physicians; (7) savoring life and managing stress with meditation, yoga, soothing music, frequent mini-vacations or breaks, and doing other activities that give you joy, inner peace and personal satisfaction.

What is a Stress Test?

A Stress Test (also termed Treadmill Test) is an examination of the heart where the patient is wired to an EKG monitor as he/she walks on a treadmill of a graduated and increasing speed and incline. This subjects the heart to "stress" and shows the cardiologist performing the test how the heart works or reacts under stress. Any abnormality shown on the EKG monitor as a sign of oxygen deprivation will suggest blockage of coronary artery. This, together with an Echocardiogram, is a very good screening test for coronary artery disease. But this does not definitely diagnose and graphically show the blockages, anatomically, in detail and with precision.

So, how is blockage of the arteries diagnosed?

For coronary artery stenosis (blockage), a practically painless dye test called coronary arteriogram or angiogram (also known as heart catheterization) is the best way to find out if there are any stenoses in the coronary arteries. This is considered the "supreme court" of heart tests, because it is the final "arbiter" to say 100% if the arteries are blocked or not. This test also gives good information on the condition of the heart muscles and its contraction. Cardiac cath is done routinely, dozens a day in some centers, for more than 35 years, and is a very safe procedure. The cardiologists doing cardiac catheterization at the Cebu Cardiovascular Center of the Cebu Doctors' Hospital affirm the safety, excellence, and indispensable value of this state-of-the-art test in the definitive diagnosis of coronary artery disease.

If blockages are found, then what?

To prevent heart attack, the blockages should either be opened with angioplasty balloon stent placement, if they are still amenable to this simpler and less invasive procedure. However, if the blockages are multiple and severe and not manageable with angioplasty, then the next prudent option to ward off heart attack is coronary bypass surgery. Thanks to modern technology, today, these wonderful life-saving procedures are available in Cebu City, performed by super specialists in invasive and non-invasive cardiology, and cardiac surgeons trained in standard cardiovascular surgery and in minimally invasive beating-heart surgery.

©2003Raoul R. Diez, M.A.O.D.