Preventing and Reversing Heart Disease For Dummies. James M. Rippe
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medicines and advice from their physicians. When angina pain changes in character, however, it can signal unstable angina or even heart attack. If you experience any of the following characteristics of chest discomfort, you need to call 911 and be taken to a hospital immediately:
✔ Pain or discomfort that is worse than you have ever experienced before
✔ Pain or discomfort that is not relieved by three nitroglycerin tablets in succession, each taken five minutes apart
✔ Pain or discomfort that is accompanied by fainting or lightheadedness, nausea, and/or cool clammy skin
✔ Pain or discomfort lasting longer than 20 minutes
If any of these symptoms occur, you need to call an ambulance and be taken immediately to a hospital. Under no circumstances should you drive yourself to the hospital.
Recognizing the Symptoms and Manifestations of Coronary Heart Disease
Because every person is an individual, physical responses to progressive coronary artery disease vary. Not every individual with heart disease has every manifestation and symptom of the condition. Individuals likewise experience specific symptoms in different ways. But these manifestations are typical:
✔ Nothing: Many people can have significant coronary atherosclerosis but experience no discomfort or other sign of the disease. That’s why this condition is known in medicine as silent ischemia. Ischemia means lack of blood flow. People with diabetes are particularly susceptible to silent ischemia, but others can have it, too.
✔ Angina: More formally known as angina pectoris, angina is typified by temporary chest pain, usually during exertion. This pain usually is felt as a tightness or uncomfortable feeling across the chest or up to the neck and jaw, not as a sharp stab. Angina also may have other manifestations.
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✔ Heart attack: Completely cutting off blood flow to a coronary artery causes an acute heart attack, or myocardial infarction (MI), the most severe result of coronary heart disease. The closure can be gradual or the result of a blood clot. A spasm in a coronary artery, particularly in the area of a narrowing, may also result in heart attack.
✔ Sudden death: The cause of sudden death from coronary heart disease often is a rhythm problem such as ventricular tachycardia or ventricular fibrillation. These rhythm problems sometimes occur in the setting of an acute heart attack. I’ve highlighted it here to make the point that the first indication or symptom for some people that they have CHD is a fatal cardiac arrest or heart attack. Many of these deaths happen to people in their 50s, 40s, or younger.
Recognizing angina, or chest pain
Angina typically is a discomfort felt in the chest, often beneath the breastbone (or sternum) or in nearby areas such as the neck, jaw, back, or arms.
✔ Individuals often describe the chest discomfort as a “squeezing sensation,” “vicelike,” “constricting,” or “ a heavy pressure on the chest.” (In fact, the term angina comes from a Greek word that means “strangling” – a strangling pain.)
✔ Angina often is brought on by physical exertion or strong emotions and typically is relieved within several minutes by resting or using nitroglycerin.
✔ Some individuals, particularly women, may experience angina as a symptom different from chest discomfort or in addition to it. Shortness of breath, nausea, faintness, abdominal pain, indigestion, or extreme fatigue may also be manifestations of angina.
✔ When chest pain occurs at rest, it usually is classified as unstable angina.
Understanding the causes of angina
Considering angina’s effect on the heart
Angina usually does not damage the heart. It is a temporary condition – the usual episode lasts only 5 to 10 minutes. (In MVD, the episodes can last longer, about 10 minutes up to 30 minutes.) Chest discomfort makes you stop and rest, slowing the heart and lessening its demand for blood. Alternatively, most people with angina know to take a nitroglycerin tablet under the tongue when they have an angina attack. The nitroglycerin dilates the coronary arteries, enabling blood flow to the heart to increase.
Diagnosing angina
An individual’s own description of the discomfort he or she experiences provides the most important information leading to the diagnosis of angina. However, your physician will typically order appropriate tests based on your symptoms and signs. These may range from an electrocardiogram, exercise stress test, or stress echocardiogram to nuclear stress testing and cardiac catheterization (see Chapter 13). Some of these tests can be conducted in your physician’s office, but others require the resources of a hospital.
Distinguishing other causes of chest pain
All chest pain is not angina and does not involve the heart. Various conditions involving other structures in the chest can occasionally cause chest discomfort; these include spasm of the esophagus, acid reflux, hiatal hernia, and muscular pain.
Treating angina
People who have angina typically can live comfortably for many years with this condition by finding out how to manage the symptoms and lower their risk factors for complications.
✔ Adjusting your approach to physical activity, leisure-time pursuits, eating habits, and other practices to reduce risk factors and control and even reduce the symptoms of angina.
✔ Modifying strenuous activities that consistently and repeatedly produce angina, by taking simple measures such as slowing your walking pace, strolling (not sprinting) to the car through the rain, vacuuming or raking more slowly, and so on.
✔ Avoiding strenuous activities that require heavy lifting, such as snow shoveling (unless you discuss it with your physician).
✔ Adding slowly progressive exercise training, under your physician’s supervision, which can dramatically increase your ability to perform enjoyable activities of daily living.
✔ Considering with your physician other interventions such as medication