Angina

Frequently Asked Questions: Angina

Here are some frequently asked questions related to angina.

Q: My doctor says that my chest pain may be angina, but more tests are needed. When my EKG was taken, it was normal. Do I really need to have a stress test?

A: Unfortunately, a simple EKG does not reliably detect angina. Therefore, the physician must perform additional tests, like an exercise stress test. The stress test is the only investigation needed for many people, since it is accurate most of the time. But even this test cannot identify exactly where or how severely the coronary arteries are blocked. So, in some people, additional tests like coronary angiography may be required.

Q: I am frightened by the idea of having to walk on a treadmill during my exercise tolerance test. Won’t that trigger my angina – or a heart attack?

A: Your physician or other trained personnel will ask about your angina symptoms during the test to make sure that you don’t overwork your heart or otherwise put it at risk. Although it may seem frightening, a treadmill is simply a machine with a band that continuously rotates during the test. Every few minutes, the band moves faster and becomes a little steeper. From your heart’s response to these stages, a lot of information is obtained on the EKG. If you are tested on a stationary bicycle, the principle is exactly the same.

Q: My wife is scheduled to have angiography. She was told that a plastic tube will be inserted through a blood vessel until it reaches her heart. Won’t that be painful – and dangerous?

A: No. Because of the anesthetic (painkiller) used during angiography, there generally is no discomfort. And people usually are given antianxiety medication before the procedure, so that they feel calm throughout. Coronary angiography only takes about 30 minutes to perform, and it is very safe. Your wife’s physician can explain any risks before the procedure.

Q: I’ve been told that I should exercise regularly for my angina. But aren’t some types of exercise dangerous?

A: Regular aerobic exercise (oxygen-using, endurance-building activity like walking, swimming, etc.) is beneficial for most people with angina. However, isometric exercise (weight lifting, push-ups, etc.) should be avoided. Isometric exercise involves contraction [squeezing] of the muscles over a long period of time. This can stress the heart by causing decompensation (inability to maintain circulation) in the left ventricle (pumping chamber), as well as a sudden increase in blood pressure. Also, people with severe myocardial ischemia (insufficient blood in the heart muscle) should not begin exercise training until their coronary arteries have been repaired by angioplasty or bypass surgery.

Q: My nutritionist says that I should eat more fish and try to cook with vegetable oils like canola. Why?

A: Cold-water varieties of fish (such as salmon, herring, tuna) – as well as certain vegetable oils like canola oil and soybean oil – are rich in polyunsaturated fatty acids known as omega-3 fatty acids. Omega-3s may help to reduce the risk of heart attack by preventing blood from clotting and sticking to the artery walls. Fish should be eaten two or three times a week to get the most advantages from omega-3s.

Q: How do you tell the difference between angina and a heart attack?

A: Some angina symptoms – such as chest pain, sweating, and nausea – may seem like a heart attack. Yet there are significant differences between these two conditions. Heart attack lasts much longer than angina (more than 20 minutes versus 1 to 10 minutes), and, unlike angina, heart attack symptoms continue even after a person rests. Heart attack is a very serious condition that results when a coronary artery in the heart is completely blocked. Heart attack can be deadly, so you should go to the hospital immediately if chest pain is:

• Getting worse or lasts longer than 20 minutes,
• Severe than previously experienced,
• Accompanied by weakness, nausea, or fainting,
• Unchanged after taking three nitroglycerin tablets, or
• Happening at an unusual time (for example, during rest).

Q: What does “unstable” angina mean?

A: “Unstable” angina is a form of angina that is much more serious than stable angina. Unstable angina occurs when a person is resting, asleep, or undergoes physical exertion. Severe discomfort may come on suddenly in someone who has never had angina before. Attacks may intensify or happen more often. Unstable angina is caused by blood clots that form around damaged plaque (fatty deposit) within a coronary artery. Sometimes the clot washes away after the damage has healed. But sometimes the clot enlarges and prevents blood flow to the heart muscle, putting the person at risk of a heart attack.

Q: How do nitroglycerin pills stop angina?

A: Nitroglycerin tablets are “vasodilators” – that is, they increase the diameter of the arteries, improving blood flow to the heart and the rest of the body. They also dilate (open up) the veins and temporarily decrease the return of blood to the heart, and this eases the workload of the heart. Once enough blood returns to the heart muscle, angina symptoms stop. The heart’s workload also becomes easier, since it can pump blood without as much resistance from narrow blood vessels.

Q: I have high blood pressure as well as angina. Do any medications treat both problems?

A: To treat both high blood pressure and angina, physicians often rely on “combination therapy” consisting of nitrate medicine plus a beta-blocker, or nitrate medicine plus a calcium channel blocker (CCB).

Q: Isn’t bypass surgery less risky than it used to be?

A: Coronary artery bypass is now commonplace and even less risky than gallbladder surgery in most people. In addition, the recovery time for bypass surgery is much shorter than it was a decade ago. All bypass patients need to spend a few days in intensive care, but they usually are discharged home after about five to seven days. Most people can return to work within a few weeks. Of course, every form of heart surgery has risks, which can be explained by a cardiologist (heart specialist) for each individual.