.. ning to the heart and lung with a stethoscope, and checking weight. Usually an experienced cardiologist can distinguish it as a cardiac or noncardiac situation within minutes. There are also routine tests, such as urine and blood tests, which can be used to determine body fat level. Blood test can also tests for: Anemia – where the level of haemogoblin is too low, and can restrict the supply of blood to the heart. Kidney function – levels of various salts, and waste products, mainly urea and creatinine in the blood.
Normally these levels should be quite low. There are other factors which can be tested such as salt level, blood fat and sugar levels. A chest x-ray provides the doctor with information about the size of the heart. Like any other muscles in the body, if the heart works too hard for a period of time, it develops, or enlarges. An electrocardiogram (ECG) is the tracing of the electrical activity of the heart.
As the heart beats and relaxes, the signals of the heart’s electrical activities are picked up and the pattern is recorded. The pattern consists of a series of alternating plateaus and sharp peaks. ECG can indicate if high blood pressure has produced any strain on the heart. It can tell if the heart is beating regularly or irregularly, fast or slow. It can also pick up unnoticed heart attacks.
A variation of the ECG is the veterocardiogram (VCG). It performs exactly like the ECG except the electrical activity is shown in the form of loops, or vectors, which can be watched on a screen, printed on paper, or photographed. What makes VCG superior to ECG is that VCG provides a three-dimensional view of a single heart beat. DRUG TREATMENT Angina patients are usually prescribed at least one drug. Some of the drugs prescribed improve blood flow, while others reduce the strain on the heart.
Commonly prescribed drugs are nitrates, beta- blockers, and Calcium antagonists. It should be noted that drugs for angina only relief the pain, it does nothing to correct the underlying disorder. Nitrates Nitroglycerine, which is the basis of dynamite, relaxes the smooth fibres of the blood vessels, allowing the arteries to dilate. They have a tendency to produce flushing and headaches because the arteries in the head and other parts of the body will also dilate. Glyceryl trinitrate is a short-acting drug in the form of small tablets.
It is taken under the tongue for maximum and rapid absorption since that area is lined with capillaries. It usually relieves the pain within a minute or two. One of the drawbacks of trinitrates is that they can be exposed too long as they deteriorate in sunlight. Trinitrates also come in the form of ointment or “transdermal” sticky patch which can be applied to the skin. Dinitrates and mononitrates are used for the prevention of angina attacks rather than as pain relievers.
They are slower acting than trinitrates, but they have a more prolonged effect. They have to be taken regularly, usually three to four times a day. Dinitrates are more common than trinitrates or tetranitrates. Beta-blockers Beta-blockers are used to prevent angina attacks. They reduce the work of the heart by regulating the heart beat, as well as blood pressure; the amount of oxygen required is thereby reduced. These drugs can block the effects of the stress hormones adrenaline and noradrenaline at sites called beta receptors in the heart and blood vessels.
These hormones increase both blood pressure and heart rate. Other sites affected by these hormones are known as alpha receptors. There are side effects, however, for using beta-blockers. Further reduction in the pumping action may drive to a heart failure if the heart is strained by heart disease. Hands and feet get cold due to the constriction of peripheral vessels.
Beta- blockers can sometimes pass into the brain fluids, and causes vivid dreams, sleep disturbance, and depression. There is also a possibility of developing skin rashes and dry eyes. Some beta- blockers raise the level of blood cholesterol and triglycerides. Calcium antagonists These drugs help prevent angina by moping up calcium in the artery walls. The arteries then become relaxed and dilated, so reducing the resistance to blood flow, and the heart receives more blood and oxygen.
They also help the heart muscle to use the oxygen and nutrients in the blood more efficiently. In larger dose they also help lower the blood pressure. The drawback for calcium antagonists is that they tend to cause dizziness and fluid retention, resulting in swollen ankles. Other Medications There are new drugs being developed constantly. Pexid, for example, is useful if other drugs fail in severe angina attacks.
However, it produces more side effects than others, such as pins and needles and numbness in limbs, muscle weakness, and liver damage. It may also precipitate diabetes, and damages to the retina. SURGERY When medications or any other means of treatment are unable to control the pain of angina attacks, surgery is considered. There are two types of surgical operation available: Coronary Bypass and Angioplasty. The bypass surgery is the more common, while angioplasty is relatively new and is also a minor operation. Surgery is only a “last resort” to provide relief and should not be viewed as a permanent cure for the underlying disease, which can only be controlled by changing one’s lifestyle.
Coronary Bypass Surgery The bypass surgery involves extracting a vein from another part of the body, usually the leg, and uses it to construct a detour around the diseased coronary artery. This procedure restores the blood flow to the heart muscle. Although this may sound risky, the death rate is actually below 3 per cent. This risk is higher, however, if the disease is widespread and if the heart muscle is already weakened. If the grafted artery becomes blocked, a heart attack may occur after the operation.
The number of bypasses depends on the number of coronary arteries affected. Coronary artery disease may affect one, two, or all three arteries. If more than one artery is affected, then several grafts will have to be carried out during the operation. About 20 per cent of the patients considered for surgery have only one diseased vessel. In 50 per cent of the patients, there are two affected arteries, and in 30 per cent the disease strikes all three arteries.
These patients are known to be suffering from triple vessel disease and require a triple-bypass. Triple vessel disease and disease of the left main coronary artery before it divides into two branches are the most serious conditions. The operation itself incorporates making an incision down the length of the breastbone in order to expose the heart. The patient is connected to a heart-lung machine, which takes over the function of the heart and lungs during the operation and also keeps the patient alive. At the same time, a small incision is made on the leg to remove a section of the vein.
Once the section of vein has been removed, it is attached to the heart. One end of the vein is sewn to the aorta, while the other end is sewn into the affected coronary artery just beyond the diseased segment. The grafted vein now becomes the new artery through which the blood can flow freely beyond the obstruction. The original artery is thus bypassed. The whole operation requires about four to five hours, and may be longer if there is more than one bypass involved. After the operation, the patient is sent to the Intensive Care Unit (ICU) for recovery.
The angina pain is usually relieved or controlled, partially or completely, by the operation. However, the operation does not cure the underlying disease, so the effects may begin to diminish after a while, which may be anywhere from a few months to several years. The only way patients can avoid this from happening is to change their lifestyles. Angioplasty This operation is a relatively new procedure, and it is known in full as transluminal balloon coronary angioplasty. It entails “squashing” the atherosclerotic plaque with balloons. A very thin balloon catheter is inserted into the artery in the arm or the leg of a patient under general anaesthetic.
The balloon catheter is guided under x-ray just beyond the narrowed coronary artery. Once there, the balloon is inflated with fluid and the fatty deposits are squashed against the artery walls. The balloon is then deflated and drawn out of the body. This technique is a much simpler and more economical alternative to the bypass surgery. The procedure itself requires less time and the patient only remains in the hospital for a few days afterward. Exactly how long the operation takes depends on where and in how many places the artery is narrowed.
It is most suitable when the disease is limited to the left anterior descending artery, but sometimes the plaques are simply too hard, making them impossible to be squashed, in which case a bypass might be necessary. SELF-HELP The only way patients can prevent the condition of their heart from deteriorating any further is to change their lifestyles. Although drugs and surgery exist, if the heart is exposed to pressure continuously and it strains any further, there will come one day when nothing works, and all that remain is a one-way ticket to heaven. The following are some advices on how people can change the way they live, and enjoy a lifetime with a healthy heart once more. Work A person should limit the amount of exertions to the point where angina might occur.
This varies from person to person, some people can do just as much work as they did before developing angina, but only at a slower pace. Try to delegate more, reassess your priorities, and learn to pace yourself. If the rate of work is uncontrollable, think about changing the job. Exercise Everyone should exercise regularly to one’s limits. This may sound contradictory that, on the one hand, you are told to limit your exertion and, on the other, you are told to exercise.
It is actually better if one exercise regularly within his or her limits. Exercises can be grouped into two categories: isotonic and isometric. People suffering from angina should limit themselves to only isotonic exercises. This means one group of muscle is relaxed while another group is contracted. Examples of this type of exercise include walking, swimming leisurely, and yoga; some harder exercises are cycling and jogging. Weight Loss The more weight there is on the body, the more work the heart has to do. Reducing unnecessary weight will reduce the amount of strain on the heart, and likely lower blood pressure as well.
One can lose weight by simply eating less than their normal intake, but keep in mind that the major goal is to cut down on fatty and sugar foods, which are low in nutrients and high in calories. Diet What you eat can have a direct effect on the kind of condition you are in. To stay fit and healthy, eat fewer animal fats, and foods that are high in cholesterol. They include fatty meat, lard, suet, butter, cream and hard cheese, eggs, prawns, offal and so on. Also, the amount of salt intake should be reduced.
Eat more food containing a high amount of fibre, such as wholegrain cereal products, pulses, wholemeal bread, as well as fresh fruits and vegetables. Alcohol, tea and coffee Alcohol in moderation does no harm to the body, but it does contain calories and may slow the weight loss progress. People can drink as much mineral water, fruit juice and ordinary or herb tea as they wish, but no more than two cups of coffee per day. Cigarettes It has been medically proven that cigarettes do the body no good at all. It makes the heart beat faster, constricts the blood vessels, and generally increases the amount of work the heart has to do. The only right thing to do is to quit smoking, it will not be easy, but it is worth the effort.
Stress Stress can actually be classified as a major risk factor, and it is one neglected by most people. Try to avoid those heated arguments and emotional situations that increase blood pressure, as well as stimulate the release of stress hormones. If they are unavoidable, try to anticipate them and prevent the attack by sucking an angina tablet beforehand. Relaxation Help your body to relax when feeling tense by sitting or lying down quietly. Close your eyes, breathe slowly and deeply through the nose, make each exhalation long, soft and steady. An adequate amount of sleep each night is always important.
Sexual activity It is true that sexual intercourse may bring on an angina attack, but the chronic frustration of abstinence may cause more tension. If intercourse precipitates angina, either suck on an angina tablet a few minutes beforehand or let your partner assume the more active role. TYPE-A BEHAVIOUR PATTERN There is a marked increase of coronary heart disease in most industrialized societies in the twentieth century. This may have resulted, in part, because these societies reward those who performed more quickly, aggressively, and competitively. Type-A individuals of both sexes were considered to have the following characteristics: (1) an intense, sustained drive to achieve self- selected but often poorly defined goals. (2) a profound inclination and eagerness to compete.
(3) a persistent desire for recognition and advancement. (4) a continuous involvement in multiple and diverse functions subject to time restrictions. (5) habitual propensity to accelerate the rate of execution of most physical and mental functions. (6) extraordinary mental and physical alertness. (7) aggressive and hostile feelings. The enhanced competitiveness of type-A persons leads to an aggressive and ambitious achievement orientation, increased mental and physical alertness, muscular tension, and an explosive and rapid style of speech. A sense of time urgency leads to restlessness, impatience, and acceleration of most activities. This in turn may result in irritability and the enhanced potential for type-A hostility and anger. Type-A individuals are thus at an increased risk of developing coronary heart disease.
The type-A behaviour pattern is defined as an action-emotion complex involving10: (1) behavioural dispositions (e.g., ambitiousness, aggressiveness, competitiveness, and impatience). (2) specific behaviours (e.g., muscle tenseness, alertness, rapid and emphatic speech stylistics, and accelerated pace of most activities). (3) emotional responses (e.g., irritation, hostility, and anger). Comparatively, type-A persons are more risky to develop coronary heart disease than type-B individuals, whose manners and behaviours are relaxed. The risk, however, is independent of the risk factors. Not all physicians are convinced that type-A behaviour pattern is a risk factor, and thousands of studies and researches are currently being done by experts on this topic.
THE CARDIAC REHAB PROGRAM This program at the Credit Valley Hospital is designed to help patients with coronary artery disease lower their overall risk, and to prevent any further attacks. It provides rehabilitation for patients who are likely to have heart attacks, have had heart attacks, or had a recent surgery. Most patients come to this one-hour class two nights a week, which takes place outside the physiotherapy department. The class is ran by volunteers, and is usually supervised by a kinesiologist. The patients come in a little before 6:00 pm, and have their blood pressure taken.
At six o’clock, volunteers will take the patients through a fifteen-minute warm-up. After the warm-up, the patients will go on with their exercise for half an hour. The patients can choose from walking, rowing machines, stationary bicycles, and arm ergometer, or a combination of two or more as their exercise. Each patient is reassessed once a month, in order to keep track of their progress. Volunteers will ask the patient being reassessed a series of questions, which includes frequency of exercise, type of exercise program, problems with exercise, etc.
About 6:30, when the patients are near the peak of their exercise, the ones being reassessed will have to have their pulse and blood pressure measured; to see if they have reached their “target heart rate”, and to see if their blood pressure goes up as expected. At about 6:45, the patients end their exercise and cool-down begins. Cool-down is in a way similar to warm-up, only this helps the patients to relax their hearts, as well as their body after a half-hour workout. After cool-down most patients have their blood pressure taken again just to make sure nothing unusual occurs. CONCLUSION Angina pectoris is not a disease which affect a person’s heart permanently, but to encounter angina pain means something is wrong. The pain is the heart’s distress signal, a built-in warning device indicating that the heart has reached its maximum workload. Upon experiencing angina, precautions should be taken.
A person’s lifestyle plays a major role in determining the chance of developing heart diseases. If people do not learn how to prevent it themselves, coronary artery disease will remain as the single biggest killer in the world, by far. BIBLIOGRAPHY 1. Amsterdam, Ezra A. and Ann M. Holms.
TAKE CARE OF YOUR HEART, New York, Facts on File, 1984. 2. Houston, B. Kent and C.R. Snyder.
TYPE A BEHAVIOUR PATTERN, John Wiley & Sons, Inc., 1988. 3. Pantano, James A. LIVING WITH ANGINA, New York, Harper & Row, 1990. 4. Patel, Chandra.
FIGHTING HEART DISEASE, Toronto, Macmillan, 1988. 5. Shillingford, J.P. CORONARY HEART DISEASE: THE FACTS, Oxford, Oxford University Press, 1982. 6.
The Heart and Stroke Foundation of Canada. CARDIOPULMONARY RESUSCITATION – BASIC RESCUER MANUAL, Canada, 1987. 7. Tiger, Steven. HEART DISEASE, New York, Julian Messner, 1986.