Dr Rachna Pande With the World Heart Day around the corner, people should understand that heart problems are preventable and angina is one of them. Angina Pectoris is the commonest manifestation of coronary artery disease. It occurs due to narrowing of the vessels that supply blood to the heart, which occurs due to deposition of fat on their inner lining. Over time, if the process goes on unchecked, blocks develop. Fat-rich diet, hypertension, diabetes, alcohol, smoking, obesity, physical and mental stress, all these are risk factors for angina and tend to aggravate it. Hereditary factors are also involved. One can develop angina due to lifestyle factors and it can pass on to the next generation. Known to be a disease of elderly people, now angina occurs in younger persons as well due to mental stress. The narrowing of lumen of coronary vessels interrupts free and easy flow of blood to the heart. When one walks or does some work, there is increased demand for oxygen by the tissues. Due to narrowing of the arteries, this demand for more blood and oxygen is left unfulfilled. The result is chest pain after exertion. The pain subsides spontaneously after the person relaxes for few minutes. The pain is commonly felt in left side of chest. From here, it can radiate to the upper back, left side of neck, arm, forearm or even index finger. It can also occur at one or more of these sites, depending on the part of heart affected. If inferior surface of the heart is involved, one can even feel pain in the stomach, after meals, thus confusing with indigestion. The typical pain felt is suffocating or cutting in nature. As one gets relief after resting for few minutes, he thinks it to be some ordinary pain and neglects it. It occurs repetitively after exertion or any movement. Untreated it can result in death of part of heart muscle, popularly known as a, “heart attack.” One can have palpitations, difficulty in breathing and sweating for few minutes along with the pain. Any chest pain if repetitive, occurring after movements should raise suspicion of angina. A chest pain which is not relieved by pain killer drugs can be angina. Diabetic patients have to be very vigilant because they can have angina without any pain. This happens because the sensation carrying nerves get damaged due to diabetes. The diagnosis of angina is confirmed by electrocardiography and cardiac echo. Coronary angiography done shows the presence and site of block in the coronary arteries. Where facilities for these tests are not available, a trial of sublingual nitrate helps to treat angina as well as confirm the diagnosis. When an individual experiences chest pain, they can keep one tablet of nitrate (anti-angina drug), below the tongue. They will get quick relief within 10 minutes, that is, if the pain is due to angina. The disease can be fairly well controlled in its nascent stage. Changes in life style like quitting smoking and alcohol, regular physical exercise and reduction of physical and mental stress, have proved to be very helpful in both prevention and good control of angina. Brisk walking, light jogging, swimming and yoga are very good exercises for patients of angina. But weight lifting or pushing should be avoided as it could aggravate the problem. Good control of hypertension and diabetes is important for good control of angina. A well-balanced healthy diet, helps in prevention of angina. A diet low in saturated fat, with plenty of fresh fruits and vegetables is the best. The patients of high blood pressure or diabetes should stick to their dietary restrictions. If drugs are prescribed for prevention or treatment of angina, they should be taken regularly. Thus, angina can be concluded that angina is a preventable heart problem. Only thing needed is a disciplined healthy, regular life. One can improve both his quality of life and survival by good control of angina. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital rachna212002@yahoo.co.uk
