Angina
Angina
De-cramp Your Heart Muscle
The pain fleetingly brushes the left side of your jaw and disappears. A few days later, it flutters along your collarbone, then drifts down into your left arm. A month after that, it resurfaces as a pressing sensation near the center of your chest.
The problem? Angina, says your doctor. And although you're not even 50 years old--too young for heart trouble, right?--angina means that your heart is not getting enough oxygen to do its job, no matter what your age.
Angina is generally caused by one of three things, says Deborah L. Keefe, M.D., professor of medicine at Cornell Medical Center and a cardiologist at Memorial Sloan-Kettering Cancer Center, both in New York City. Angina can result from a spasm in the wall of the coronary artery that temporarily constricts the artery and cuts off the heart's blood supply for a moment or two. Or a heart wall that has been thickened by high blood pressure can demand more oxygen than the red blood cells in your blood can supply. Or a wandering blood clot can momentarily lodge in an artery that has been narrowed by a lifelong passion for eggs sunny-side up.
"Angina is rare in premenopausal women," says Dr. Keefe. When it does occur before menopause, more than likely it's caused by arterial spasm. After menopause it is more than likely caused by narrowed arteries.
When To See A Doctor
If angina lasts for 20 minutes, you should either call an ambulance or go immediately to a hospital emergency room. Don't bother calling your doctor and waiting for a return call, she adds. If you're having a heart attack, and not angina, the faster you get medical treatment (say, with clot-busting drugs), the less likely you'll be to suffer permanent heart damage.
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Whatever your age or the cause, though, the real danger isn't angina itself but a shutdown that lasts more than a few minutes, according to Vera Bittner, M.D., associate professor of medicine at the University of Alabama School of Medicine in Birmingham. A complete shutdown in delivery of blood to the heart will lead to a full-blown heart attack.
Fortunately, "not everyone who has angina goes on to have a heart attack," says Pamela Ouyang, M.D., associate professor of medicine at Johns Hopkins University School of Medicine and a cardiologist at Johns Hopkins Bayview Medical Center, both in Baltimore. "In fact, in women angina seems less likely to lead to heart attack than in men."
OXYGENATE YOUR HEART
If you have angina, your doctor will probably give you a prescription for nitroglycerin (such as Nitrostat), medication that dilates the heart's arteries, says Dr. Ouyang. Follow your doctor's directions carefully. She'll probably suggest that you take one tablet at the first twinge of pain and wait five minutes to see if the pain goes away. If it doesn't, she'll probably tell you to take a second tablet and wait another five minutes. And if that doesn't do the trick, your doctor will probably suggest that you take a third tablet.
To help relieve angina and avoid repeat episodes, doctors also recommend the following measures.
Sit down. Medication or no, your first response to angina should be to sit down and relax, says Dr. Ouyang. If you're having an arterial spasm, it will subside in a minute or two and release its grip on your artery. If clogged arteries are to blame, relief upon resting may suggest that whatever you were doing when the pain hit required more oxygen than your clogged arteries could deliver. Sitting down reduces the workload on your heart and should relieve the pain.
Target cholesterol. Following a program aimed at lowering cholesterol can also head off angina triggered by arterial spasms, says Dr. Bittner, because accumulations of cholesterol can interfere with the smooth operation of the endothelium, the lining of your blood vessels.
Leave smoking to the woodstove. Cigarette smoke sucks oxygen out of your blood and constricts blood vessels, triggering angina rooted in either arterial spasm or narrowed arteries, says Dr. Keefe. If you're not a smoker, don't start. And if you do smoke, try your best to quit.
Slim down. Carrying extra pounds exacerbates high blood pressure, and high blood pressure can exacerbate angina, says Dr. Bittner. So losing excess weight can minimize angina.
De-stress. Anything that adds to your heart's workload requires additional oxygen, which in turn can lead to angina if you are already susceptible. So any steps that you can take to help minimize stress--like delegating what you don't have time to do or learning not to overreact--can help.
Get an exercise prescription. Even though the first response to angina is rest, that doesn't mean that you should sit around when you're not actually having pain, says Dr. Bittner. Like most other muscles, the heart is a workhorse; it needs exercise to stay in shape. A well-conditioned heart uses oxygen more efficiently and is less prone to angina.
If you have angina, your cardiologist will probably order a treadmill test to determine what kind of exercise (and how much) you should get to put your heart in peak condition.
