By Jeff Harr, RCEP, Coordinator of BMH Cardiac Rehab and Burton Tepfer, MD
Angina is defined as acute pain in the chest resulting from decreased blood supply to the heart muscle. This is most often the result of a blockage to one or more of the coronary arteries that supply the heart muscle with blood, nutrients, and oxygen.
Risk factors for the development of these blockages are: increased cholesterol levels, high blood pressure, diabetes, being overweight or obese, inactivity, tobacco use, chronic stress, positive family history, and increasing age. Symptoms include chest pain, pressure, tightness, and heaviness. The symptoms may radiate to the neck, throat, lower jaw, shoulders, down arms, or even into your back. Symptoms sometimes may not be felt in the chest at all. It may be associated with shortness of breath, indigestion, or nausea. Symptoms usually occur with physical activity – when the heart beats faster and needs more blood and oxygen. The blockage prevents the needed blood and oxygen from getting to the heart muscle. It can also occur when a person becomes emotionally upset, and the heart beats faster and needs more oxygen. It is considered stable angina if it is predictable. You know when it will occur and with which activities. It does not change in character, frequency, intensity, or duration. If angina occurs at rest, or is increasing in frequency or intensity, or has irregular timing, then it is considered unstable angina.
If you are having any of the symptoms mentioned above, or anything similar, you need to make an appointment with your physician. Tests may be done to determine if the discomfort is caused by a blockage in an artery to your heart and, if it is, you need to have a discussion with your physician to decide the next step. You may be given medication alone or you may need an intervention, such as a stent (a metal scaffold placed in the artery by a catheter), or a bypass surgery done if the blockage is severe or if you have multiple blockages.
No matter what the next step is, there are two things that will occur. You will be placed on medications to prevent your angina and help to prevent a heart attack. One of the medications will be nitroglycerine. You will be told to carry the nitroglycerine with you and only use it if you have angina. If angina occurs, you should sit down and place one nitroglycerine tablet under your tongue and allow it to dissolve. You should then wait five minutes and, if you have no relief of your symptoms, place another tablet under your tongue. You would then wait another five minutes and, if you still have no relief, you would place a third tablet under your tongue after which you should call 911 to get immediate help. It may be a sign that you are having a heart attack if three nitroglycerine tablets have not relieved your discomfort. Other medications can treat angina by decreasing cholesterol levels, blood pressure, and heart rate.
You should consider lifestyle modifications if you are experiencing angina, or chest pains, regardless of medications, stent or bypass surgery. Many of the risk factors for heart disease can be modified or controlled. Making lifestyle changes to reverse those risk factors can prevent blockages from becoming larger, may help reduce the size of a blockage, and may also help prevent other blockages from occurring in any of your arteries.
Cardiac Rehabilitation programs were developed to help people with these lifestyle changes. These programs are located in hospitals across the United States. They provide education for dietary changes, medications, losing weight, blood pressure and diabetes control, exercise, and stress management techniques. Anyone who has angina or has had a heart attack, stent, bypass surgery, heart valve surgery, or a heart transplant is eligible for Cardiac Rehabilitation. The American Association of CardioVascular and Pulmonary Rehabilitation (AACVPR) has an online data base searchable by state at www.aacvpr.org under its resource tab to search for cardiac rehab programs. Brattleboro Memorial Hospital has a Cardiac Rehab program which is certified by the AACVPR. Cardiac Rehab programs can help you manage your symptoms, make lifestyle changes, and help you lead a normal active life.
The author, Jeff Harr, a registered clinical exercise physiologist, is coordinator of the BMH Cardiac and Pulmonary Rehab Programs. He worked along with BMH internist Burton Tepfer, MD, in writing this article. Dr. Tepfer’s subspecialty is cardiology, and he is Medical Director of the hospital’s Cardiac Rehab Program.