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It is all about supply and demand. The heart needs a plentiful supply of oxygen and nutrients to effectively nourish the body. When the body’s body’s demand exceeds the heart’s supply, complications arise. This imbalance between demand and supply results from high blood pressure and vessel narrowing leading to lack of oxygen and nutrients to the heart, referred to as angina or chest pain.
What are the risks?
Risks include age of > or= 45 in males, > or = 65 in females, family history of < = 55 in male first degree relative and < or=65 in female first degree relative, high blood pressure, high cholesterol, cigarette smoking, diabetes, and sedentary lifestyle .
What are the symptoms?
The pain can be described as left shoulder, lower jaw radiating pressure or discomfort with pressure, heaviness, tightness lasting 30 seconds to 30 minutes accompanied by weakness, shortness of breath, sweating, and/or nausea/vomiting. In addition, individuals may be asymptomatic.
How is it different from other common
disease states?
Other disease states confused with angina are pneumonia, reflux, anxiety, and pulmonary emboli. Diagnosis is dependent on electrocardiograph, echo-cardiograph, exercise stress test, and angiograph. Electrocardiograph measures heart rhythm. Echocardiograph measures heart function. Exercise stress test reveals at what effort level the heart becomes compromised. Angiograph measures the vessel blockage. Angina in comparison to the other similar disease states last for shorter period of time and is relieved by rest or nitroglycerin.
What are the treatment options?
Treatments include revascularization and/or medication. Revascularization entails percutaneous intervention or the placement of a stent or balloon catheter or coronary artery bypass surgery. Medications include aspirin, beta blockers, calcium channel blockers, nitrates, and ranolazine. The type of treatment chosen depends on the individual’s presentation and risks. Standards of angina resolution involve the ABCDEs. A= aspirin and anti-anginal therapy, B=beta blocker and blood pressure, C=cigarette smoking and cholesterol D=diet and diabetes and E=education.
How do these treatments help?
These interventions either reduce the demand on the heart or increase the nourishing supply to the heart or both. The surgical corrections open the pathways allowing for a consistent nutrient and oxygen supply to the heart muscle. The medications work in various methods. Anti-platelet agents such as aspirin and generic Plavix reduce the “stickiness” of the blood, decreasing the clotting ability and plaque formations. Agents such as beta blockers, calcium channel blockers, and nitrates assist in slowing the heart rate and thus the demand, increasing the contractility and thus improving heart’s efficacy, and vessel vasodilation and thus increasing supply of oxygen and nutrients. Ranolazine’s mechanism of action is unique and reserved for prior treatment unresponsiveness. As discussed previously, as an individual inflicted with chest pain, lifestyle interventions are significant components to improving and preventing the initiation and anginal progression.
What preventative strategies exist?
Eating a healthy diet along with exercising is extremely significant in lowering risks. The diet entails < 200 mg of cholesterol, < 150 mg triglycerides, < 7% saturated fat, minimal to no trans-fat, < 1.5 g sodium, < 200 mg of caffeine, < 2 alcoholic drinks in males per day and 1 drink in females, increased fruits, vegetables, and lean sources of protein, low-fat dairy along with moderate to vigorous exercise 30 minutes most days of the week (5-7) all to achieve or maintain a normal body mass index between 18.5 and 24.9. Along with these behaviors includes lowering blood pressure to < 140/90, triglycerides to < 150, hemoglobin A1c (if diabetic) < 7% or as discussed with physician. An additional lifestyle modification includes smoking cessation if a smoker as well as adhering to medications.
It’s your heart.
It should be
personal.
And that’s how I treat it.
When you come to see me… that’s exactly who you will see. I will know your name, how many children you have, what foods you love to eat and how much sleep you get each night. I will take your health personally. That is why I am the only doctor you will see when you come to my office. I will take time with you and get to know you personally. No patient of mine will ever have to see an associate or undergo needless testing. I will know which tests are needed and which aren’t. I will watch over you and treat you as I want to be treated when, one day, I am the patient and not the doctor. And that is my promise to you.
