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A USER’S GUIDE OF YOUR HEART: ANGINA PECTORIS
The first inkling many patients have that something is wrong may be a pain in the chest, arms, or jaw known as angina pectoris, commonly referred to as angina. The term literally means a pain or strangling in the chest. Symptoms vary from patient to patient. I felt mine in the left arm and jaw. Others say it was the right, rather than the left, arm. I never felt any chest discomfort, but most patients do. How does the pain and discomfort orginate?
The heart muscle has nerves that transmit pain signals to the brain just like any other organ, but pain fibres in the heart are sensitive only to inflammation or a lack of oxygen. The angina most of us are familiar with occurs when the myocardium doesn’t get enough oxygen, usually because of an obstruction or constriction of the blood vessels. Because of the way nerves are interconnected, we might experience pain in the shoulder, arm or jaw as well as in the chest. Angina signals that the muscle has become oxygen deficient, a state of affairs known as ischaemia.
But ischaemia can also be silent, with no painful symptoms at all. Your heart can be in trouble, and you don’t know about it. The American Heart Association estimates that three to four million Americans may have these painless episodes of silent ischaemia. Such individuals often go undiagnosed, and the first symptom may be a heart attack, sometimes a fatal one. In a way, then, angina is a valuable warning signal, one that should never be ignored.
Angina may occur during exercise, emotional stress, or excitement, or even while asleep or at rest. After a rest, the pain typically dissipates. And some patients may take nitroglycerin tablets, dissolved under the tongue, to dilate the heart’s coronary arteries enough to get the blood flowing to supply the needed oxygen.
While most angina is the result of blockage within the coronary artery, some instances may result from a spasm in the artery, effectively reducing flood flow. No one is sure why such spasms occur. The phenomenon baffled physicians in the past who were able to detect no blockage sufficient to cause the angina, yet patients complained of the pain. Such patients today can be treated with a new class of drugs, the calcium channel blockers, which prevent the spasms from occurring. Details on these and other heart drugs are in chapter 16.
The decrease in blood flow to the heart during an episode of angina is usually only temporary and does not actually damage the heart. But if angina is ignored, it will get worse and may eventually cause damage. A rule of thumb states that angina usually lasts 15 to 30 seconds, not more than one minute. If pain exceeds one or two minutes and does not respond to rest or nitroglycerin, it may be owing to a heart attack. Far better to be safe than sorry, seek medical attention immediately.
For a while you’re going to be overly sensitive to any discomfort, thinking that it’s either angina or a heart attack. That’s a natural reaction and all I can say, having gone through it myself, is that this, too, shall pass. You’re understandably suspicious right now. But there are other reasons for the pains and discomfort. I discuss these starting on page 104, since many have nothing whatever to do with your heart and others are temporary phenomena which result from the trauma your heart has experienced. But if there’s any doubt in your mind, call the doctor or get immediate medical attention.
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