DEAR DR. ROACH: Could you write about the effect that angina, stopped quickly by nitro, has on one’s system? My husband takes Imdur (30 mg) twice a day to control angina, although he still experiences it several times a week, necessitating a nitroglycerin pill. Sometimes angina comes from exertion, such as climbing stairs a few times or doing home-maintenance chores. He is 89 and in relatively good health. He has had bypass surgery and several catheterizations, with eight stents. He doesn’t need a cane or use oxygen. His cardiologist suggested EECP, which my husband does not want to endure, believing the medicines are working fine.
His quality of life is good – angina does not interfere with going out and enjoying himself. Is he taking angina too lightly because he can stop it by popping a nitro? – M.W.
ANSWER: Angina pectoris literally means “chest pain,” but in my experience people with angina due to blockages in the arteries of the heart are more likely to complain of pressure or tightness than actual pain. Angina occurs when the heart’s demand for blood oxygen exceeds the supply. This usually means during exercise. If the blood supply is fixed due to a blockage in the heart, the heart simply can’t get enough oxygen above a certain level of exercise. If the person with angina stops exercising, the demand for oxygen goes back down below what can be supplied, and the angina goes away. Stable angina is associated with a low risk for heart attack.
Medications like isosorbide (Imdur) and nitroglycerine work by dilating the blood vessels in order to increase supply. These medicines also dilate veins, which reduces the demands on the heart. Stents are designed to keep blockages open. Nonetheless, there are many people who continue to have angina despite what can be done with medicine and stents.
EECP (enhanced external counterpulsation) is a new technique. Cuffs wrapped around the legs are synchronized with the EKG and squeeze strongly when the heart is at rest. This forces blood backward through the arteries and into the blood vessels of the heart. It may work by making some blood vessels larger, but the exact mechanism isn’t clear. EECP is used for people with stable angina. It takes 35 hours of EECP over four to seven weeks to get benefits, and about 70 percent of people had improvement from severe angina to mild or none. EECP is a big investment of time, and is usually reserved for people whose angina is more disabling than your husband’s.
At 89, your husband certainly is entitled to say he is doing fine the way he is and not wanting further treatments.
Coronary artery disease can go unnoticed until you have a heart attack. The booklet on the disease explains its causes, symptoms (such as angina) and treatment. Readers can order a copy by writing: Dr. Roach – No. 101W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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