Angina Pectoris: A malady of modern times

World Heart day (29th September) every year is meant to create awareness among people regarding prevention of heart diseases. Angina is a form of ischemic heart disease, i.e. disease which occurs due to reduced blood supply to the heart. With increase in modernization, angina has emerged as a major public health problem in both developed and developing countries. The typical stabbing, vice-like pain occurs in the left side of the chest with radiation to the left arm. The pain can radiate to the left jaw, left middle finger or even the left side of the back depending on the part of heart affected. It comes after any precipitating event like walking, doing some work or any sort of physical or mental excitement. People prone to it are known to develop chest pain while watching some exciting match or even while making love. This lasts for few seconds to minutes and subsides spontaneously or when the precipitating activity stops. There may be associated breathlessness, restlessness, sweating and palpitations. Because of the decreased blood supply to the heart, adrenalin is released in the body which further augments the coronary spasm. As the patient rests, the spasm is relieved and pain disappears. This ischemia can augment leading to a full fledged heart attack. Initially, angina used to be considered a disease of middle aged and elderly people but it is now occurring in youngsters also. As affluence increases, incidences of angina are also increasing. Young women are marginally protected from it due to feminizing hormones, but after menopause they are as prone to it as men. Many individuals tend to ignore the fleeting pain they experience while doing some work. It is only when the problem becomes severe or persistent that they go for treatment. A variant form of angina is the one that occurs during rest. A high index of suspicion is needed to diagnose it. Risk factors which make one more prone to develop angina are obesity, high fat diet, lack of physical exercise, hypertension, diabetes mellitus, smoking and alcoholism. A strong hereditary susceptibility also exists. Physical and mental stress increases the risk for angina. Diagnosis is made on suspicion and tests like electrocardiography, cardiac echo and treadmill test. In treadmill test, a person is subjected to stress by making him move on a belt with increasing speed and incline. One prone to angina develops typical chest pain and E.C.G. changes while walking on it. One tablet of low dose anti-anginal drug when put below the tongue on experiencing chest pain provides relief in 5 to 10 minutes. This can be used for confirming diagnosis of angina where other tests are not feasible. If episodes become recurrent, more frequent, with longer duration of pain, angiography (visualizing coronary vessels by injecting a dye) is needed and interventions are done to remove any block. It is important to adopt preventive measures for angina. Over eating, late nights, alcohol, smoking, should be given up. Regular exercises like walking, light jogging, aerobics, yoga e.t.c. are useful. Weight reduction is important in obese persons. Frequent small meals are desirable as compared to one or two heavy meals. Undue physical exertion or mental tension should be avoided. One strenuous activity which is often not realized is talking. While talking, when one is excited, adrenalin released is augmented which can precipitate angina. Therefore it is desirable that one speaks less and softly. So one has to be careful. Just a change towards healthier life style, including healthy diet, exercise and relaxation can keep off angina. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital

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Angina Pectoris: A malady of modern times