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Angina Pectoris
CONTENTS
3 Introduction
4 The Human Heart
5 Symptoms of Coronary Heart Disease
5 Heart Attack
5 Sudden Death
5 Angina
6 Angina Pectoris
6 Signs and Symptoms
7 Different Forms of Angina
8 Causes of Angina
9 Atherosclerosis
9 Plaque
10 Lipoproteins
10 Lipoproteins and Atheroma
11 Risk Factors
11 Family History
11 Diabetes
11 Hypertension
11 Cholesterol
12 Smoking
12 Multiple Risk Factors
13 Diagnosis
14 Drug Treatment
14 Nitrates
14 Beta-blockers
15 Calcium antagonists
15 Other Medications
16 Surgery
16 Coronary Bypass Surgery
17 Angioplasty
18 Self-Help
20 Type-A Behaviour Pattern
21 Cardiac Rehab Program
22 Conclusion
23 Diagrams and Charts
26 Bibliography
INTRODUCTION
In today's society, people are gaining medical knowledge at quite a
fast pace. Treatments, cures, and vaccines for various diseases and
disorders are being developed constantly, and yet, coronary heart disease
remains the number one killer in the world.
The media today concentrates intensely on drug and alcohol abuse,
homicides, AIDS and so on. What a lot of people are not realizing is that
coronary heart disease actually accounts for about 80% of all sudden deaths.
In fact, the number of deaths from heart disease approximately equals to
the number of deaths from cancer, accidents, chronic lung disease,
pneumonia and influenza, and others, COMBINED.
One of the symptoms of coronary heart disease is angina pectoris.
Unfortunately, a lot of people do not take it seriously, and thus not
realizing that it may lead to other complications, and even death.
THE HUMAN HEART
In order to understand angina, one must know about our own heart. The
human heart is a powerful muscle in the body which is worked the hardest. A
double pump system, the heart consists of two pumps side by side, which
pump blood to all parts of the body. Its steady beating maintains the flow
of blood through the body day and night, year after year, non-stop from
birth until death.
The heart is a hollow, muscular organ slightly bigger than a person's
clenched fist. It is located in the centre of the chest, under the
breastbone above the sternum, but it is slanted slightly to the left,
giving people the impression that their heart is on the left side of their
chest.
The heart is divided into two halves, which are further divided into
four chambers: the left atrium and ventricle, and the right atrium and
ventricle. Each chamber on one side is separated from the other by a valve,
and it is the closure of these valves that produce the "lubb-dubb" sound so
familiar to us. (see Fig. 1 - The Structure of the Heart)
Like any other organs in our body, the heart needs a supply of blood
and oxygen, and coronary arteries supply them. There are two main coronary
arteries, the left coronary artery, and the right coronary artery. They
branch off the main artery of the body, the aorta. The right coronary
artery circles the right side and goes to the back of the heart. The left
coronary artery further divides into the left circumflex and the left
anterior descending artery. These two left arteries feed the front and the
left side of the heart. The division of the left coronary artery is the
reason why doctors usually refer to three main coronary arteries. (Fig. 2 -
Coronary Arteries)
SYMPTOMS OF CORONARY HEART DISEASE
There are three main symptoms of coronary heart disease: Heart Attack,
Sudden Death, and Angina.
Heart Attack
Heart attack occurs when a blood clot suddenly and completely blocks a
diseased coronary artery, resulting in the death of the heart muscle cells
supplied by that artery. Coronary and Coronary Thrombosis2 are terms that
can refer to a heart attack. Another term, Acute myocardial infarction2,
means death of heart muscle due to an inadequate blood supply.
Sudden Death
Sudden death occurs due to cardiac arrest. Cardiac arrest may be the
first symptom of coronary artery disease and may occur without any symptoms
or warning signs. Other causes of sudden deaths include drowning,
suffocation, electrocution, drug overdose, trauma (such as automobile
accidents), and stroke. Drowning, suffocation, and drug overdose usually
cause respiratory arrest which in turn cause cardiac arrest. Trauma may
cause sudden death by severe injury to the heart or brain, or by severe
blood loss. Stroke causes damage to the brain which can cause respiratory
arrest and/or cardiac arrest.
Angina
People with coronary artery disease, whether or not they have had a
heart attack, may experience intermittent chest pain, pressure, or
discomforts. This situation is known as angina pectoris. It occurs when the
narrowing of the coronary arteries temporarily prevents an adequate supply
of blood and oxygen to meet the demands of working heart muscles.
ANGINA PECTORIS
Angina Pectoris (from angina meaning strangling, and pectoris meaning
breast) is commonly known simply as angina and means pain in the chest. The
term "angina" was first used during a lecture in 1768 by Dr. William
Heberden. The word was not intended to indicate "pain," but rather
"strangling," with a secondary sensation of fear.
Victims suffering from angina may experience pressure, discomfort, or
a squeezing sensation in the centre of the chest behind the breastbone. The
pain may radiate to the arms, the neck, even the upper back, and the pain
may come and go. It occurs when the heart is not receiving enough oxygen to
meet an increased demand.
Angina, as mentioned before, is only temporarily, and it does not
cause any permanent damage to the heart muscle. The underlying coronary
heart disease, however, continues to progress unless actions are taken to
prevent it from becoming worse.
Signs and Symptoms
Angina does not necessarily involve pain. The feeling varies from
individuals. In fact, some people described it as "chest pressure," "chest
distress," "heaviness," "burning feeling," "constriction," "tightness," and
many more. A person with angina may feel discomforts that fit one or
several of the following descriptions:
- Mild, vague discomfort in the centre of the chest, which
may radiate to the left shoulder or arm - Dull ache, pins and
needles, heaviness or pains in the
arms, usually more severe in the left arm - Pain that feels
like severe indigestion - Heaviness, tightness, fullness, dull ache,
intense
pressure, a burning, vice-like, constriction, squeezing
sensation in the chest, throat or upper abdomen - Extreme
tiredness, exhaustion of a feeling of collapse - Shortness of breath,
choking sensation - A sense of foreboding or impending death
accompanying
chest discomfort - Pains in the jaw, gums, teeth, throat or ear
lobe - Pains in the back or between the shoulder blades
Angina can be so severe that a person may feel frightened, or so mild
that it might be ignored. Angina attacks are usually short, from one or two
minutes to a maximum of about four to five. It usually goes away with rest,
within a couple of minutes, or ten minutes at the most.
Different Forms of Angina
There are several known forms of angina. Brief pain that comes on
exertion and leave fairly quickly on rest is known as stable angina. When
angina pain occurs during rest, it is called unstable angina. The symptoms
are usually severe and the coronary arteries are badly narrowed. If a
person suffers from unstable angina, there is a higher risk for that person
to develop heart attacks. The pain may come up to 20 times a day, and it
can wake a person up, especially after a disturbing dream.
Another type of angina is called atypical or variant angina. In this
type of angina, pain occurs only when a person is resting or asleep rather
than from exertion. It is thought to be the result of coronary artery spasm,
a sort of cramp that narrows the arteries.
Causes of Angina
The main cause of angina is the narrowing of the coronary arteries. In
a normal person, the inner walls of the coronary arteries are smooth and
elastic, allowing them to constrict and expand. This flexibility permits
varying amounts of oxygenated blood, appropriate to the demand at the time,
to flow through the coronary arteries. As a person grows older, fatty
deposits will accumulate on the artery walls, especially if the linings of
the arteries are damaged due to cigarette smoking or high blood pressure.
As more and more fatty materials build up, they form plaques which
causes the arteries to narrow and thus restricting the flow of blood. This
process is known as atherosclerosis. However, angina usually does not occur
until about two-thirds of the artery's diameter is blocked. Besides
atherosclerosis, there are other heart conditions resulting in the
starvation of oxygen of the heart, which also causes angina.
The nerve factor - The arteries are supplied with nerves, which allow
them to be controlled directly by the brain, especially the hypothalamus -
an area at the centre of the brain which regulates the emotions. The brain
controls the expanding and narrowing of the arteries when necessary. The
pressures of modern life: aggression, hostility, never-ending deadlines,
remorseless, competition, unrest, insecurity and so on, can trigger this
control mechanism.
When you become emotional, the chemicals that are released, such as
adrenaline, noradrenaline, and serotonin, can cause a further constriction
of the coronary arteries. The pituitary gland, a small gland at the base of
the brain, under the control of the hypothalamus, can signal the adrenal
glands to increase the production of stress hormones such as cortisol and
adrenaline even further.
Coronary spasm - Sudden constrictions of the muscle layer in an artery
can cause platelets to stick together, temporarily restricting the flow of
flow. This is known as coronary spasm. Platelets are minute particles in
the blood, which play an essential role both in the clotting process and in
repairing any damaged arterial walls. They tend to clump together more
easily when the blood is full of chemicals released during arousal, such as
cortisol and others.
Coronary spasm causes the platelets to stick together and to the wall
of the artery, while substances released by the platelets as they stick
together further constrict the blood vessels. If the artery is already
narrowed, this can have a devastating effect as it drastically reduces the
blood flow. (Fig. 3 - Spasm in a coronary artery)
When people are very tense, they usually overbreathe or hold their
breath altogether. Shallow, irregular but rapid breathing washes out carbon
dioxide from the system and the blood will become over-oxygenated. One
might think that the more oxygen in the blood the better, but overloaded
blood actually does not give up oxygen as easily, therefore the amount of
oxygen available to the heart is reduced. Carbon dioxide is present in the
blood in the form of carbonic acid, when there is a loss in carbonic acid,
the blood becomes more basic, or alkaline, which leads to spasm of blood
vessels, almost certainly in the brain but also in the heart.
ATHEROSCLEROSIS
The coronary arteries may be clogged with atherosclerotic plaques,
thus narrowing the diameter. Plaques are usually collections of connection
tissue, fats, and smooth muscle cells. The plaque project into the lumen,
the passageway of the artery, and interfere with the flow of blood. In a
normal artery, the smooth muscle cells are in the middle layer of the
arterial wall; in atherosclerosis they migrate into the inner layer. The
reason behind their migration could hold the answers to explain the
existence of atherosclerosis. Two theories have been developed for the
cause of atherosclerosis.
The first theory was suggested by German pathologist Rudolf Virchow
over 100 years ago. He proposed that the passage of fatty material into the
arterial wall is the initial cause of atherosclerosis. The fatty material,
especially cholesterol, acts as an irritant, and the arterial wall respond
with an outpouring of cells, creating atherosclerotic plaque.
The second theory was developed by Austrian pathologist Karl von
Rokitansky in 1852. He suggested that atherosclerotic plaques are
aftereffects of blood-clot organization (thrombosis). The clot adheres to
the intima and is gradually converted to a mass of tissue, which evolves
into a plaque.
There are evidences to support the latter theory. It has been found
that platelets and fibrin (a protein, the final product in thrombosis) are
often found in atherosclerotic plaques, also found are cholesterol crystals
and cells which are rich in lipid. The evidence suggests that thrombosis
may play a role in atherosclerosis, and in the development of the more
complicated atherosclerotic plaque. Though thrombosis may be important in
initiating the plaque, an elevated blood lipid level may accelerate
arterial narrowing.
Plaque
Inside the plaque is a yellow, porridge-like substance, consisting of
blood lipids, cholesterol and triglycerides. These lipids are found in the
bloodstream, they combine with specific proteins to form lipoproteins. All
lipoprotein particles contain cholesterol, triglycerides, phospholipids,
and proteins, but the proportion varies in different particles.
Lipoproteins
Lipoproteins all vary in size. The largest lipoproteins are called
Chylomicra, and consist mostly of triglycerides. The next in size are the
pre-beta-lipoproteins, then the beta lipoproteins. As their size decreases,
so do their concentration of triglycerides, but the smaller they are, the
more cholesterol they contain. Pre-beta-lipoproteins are also known as low
density lipoproteins (LDL), and beta lipoproteins are also called very low
density lipoproteins (VLDL). They are most significant in the development
of atheroma. The smallest lipoprotein particles, the alpha lipoproteins,
contain a low concentration of cholesterol and triglycerides, but a high
level of proteins, and are also known as high density lipoproteins (HDL).
They are thought to be protective against the development of
atherosclerotic plaque. In fact, they are transported to the liver rather
than to the blood vessels.
Lipoproteins and Atheroma
The theory is that lipoproteins pass between the lining cells of the
arteries and some of them accumulate underneath. All except the chylomicra,
which are too big, have a chance to accumulate. The protein in the
lipoproteins are broken down by enzymes, leaving behind the cholesterol and
triglycerides. These fats are trapped and set up a small inflammatory
reaction. The alpha particles do not react with the enzymes are returned to
the circulation.
RISK FACTORS
There are several risk factors that contribute to the development of
atherosclerosis and angina: Family history, Diabetes, Hypertension,
Cholesterol, and Smoking.
Family History
We all carry approximately 50 genes that affect the function and
structure of the heart and blood vessels. Genetics can determine one's risk
of having heart disease. There are many cases today where heart disease
runs in a family, for many generations.
Diabetes
Diabetics are at least twice as likely to develop angina than
nondiabetics, and the risk is higher in women than in men. Diabetes causes
metabolic injury to the lining of arteries, as a result, the tiny blood
vessels that nourish the walls of medium-size arteries throughout the body,
including the coronary arteries, become defective. These microscopic
vessels become blocked, impeding the delivery of blood to the lining of the
larger arteries, causing them to deteriorate, and artherosclerosis results.
Hypertension
High blood pressure directly injures the artery lining by several
mechanisms. The increased pressure compresses the tiny vessels that feed
the artery wall, causing structural changes in these tiny arteries.
Microscopic fracture lines then develop in the arterial wall. The cells
lining the arteries are compressed and injured, and can no longer act as an
adequate barrier to cholesterol and other substances collecting in the
inner walls of the blood vessels.
Cholesterol
Cholesterol has become one of the most important issues in the last
decade. Reducing cholesterol intake can directly decrease one's risk of
developing heart disease, and people today are more conscious of what they
eat, and how much cholesterol their foods contain.
Cholesterol causes atherosclerosis by progressively narrowing the
arteries and reduces blood flow. The building up of fatty deposits actually
begins at an early age, and the process progresses slowly. By the time the
person reaches middle-age, a high cholesterol level can be expected.
Smoking
It has been proven that about the only thing smoking do is shorten a
person's life. Despite all the warnings by the surgeon general, people
still manage to find an excuse to quit smoking.
Cigarette smoke contains carbon monoxide, radioactive polonium,
nicotine, arsenious oxide, benzopyrene, and levels of radon and molybdenum
that are TWENTY times the allowable limit for ambient factory air. The two
agents that have the most significant effect on the cardiovascular system
are carbon monoxide and nicotine.
Nicotine has no direct effect on the heart or the blood vessels, but
it stimulates the nerves on these structures to cause the secretion of
adrenaline. The increase of adrenaline and noradrenaline increases blood
pressure and heart rate by about 10% for an hour per cigarette. In simpler
words, nicotine causes the heart to beat more vigorously. Carbon monoxide,
on the other hand, poisons the normal transport systems of cell membranes
lining the coronary arteries. This protective lining breaks down, exposing
the undersurface to the ravages of the passing blood, with all its clotting
factors as well as cholesterol.
Multiple Risk Factors
The five major risk factors described above do more than just add to
one another. There is a virtual multiplication effect in victims with more
than one risk factor. (Chart: Risk Factors)
DIAGNOSIS
It is very important for patients to tell their doctors of the
symptoms as honestly and accurately as possible. The doctor will need to
know about other symptoms that may distinguish angina from other conditions,
such as esophagitis, pleurisy, costochondritis, pericarditis, a broken rib,
a pinched nerve, a ruptured aorta, a lung tumour, gallstones, ulcers,
pancreatitis, a collapsed lung or just be nervous. Each of the above
mentioned is capable of causing chest pain.
A patient may take a physical examination, which includes taking the
pulse and blood pressure, listening 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.
Fig. 3 Spasm in a coronary artery
RISK FACTORS
Average Risk = 100
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨ UŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3 3 3 3 3
3NONE 3 3 3 77 3
3 3 3 3 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU AŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨ UŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3 3 3 3 3
3CIGARETTES 3 3 3 120 3
3 3 3 3 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU AŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨ UŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3CIGARETTES 3 3 3 3
3AND CHOLESTEROL 3 3 3 236 3
3 3 3 3 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU AŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨ UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽ¨
3CIGARETTES, 3 3 3 3
3CHOLESTEROL, AND 3 3 3 384 3
3HIGH BLOOD PRESSURE3 3 3 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU AŽŽŽAŽŽŽŽŽAŽŽŽŽŽAŽŽŽŽAAŽŽŽŽŽAŽU 100 200 300
400 500
For purpose of illustration, this chart uses as abnormal a blood
pressure level of 180 systolic and a very high cholesterol level of 310 in
a 45-year-old man.
CORONARY HEART DISEASE AND MULTIPLE FACTORS
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND CIGARETTES 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3HIGH CHOLESTEROL AND CIGARETTES 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3CIGARETTES 3
AŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽ¨
3NONE 3
AŽŽŽŽŽŽŽŽU
UŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ¨
3LOW 3 1 1/2 times 3 3 times 3 5 times 3
AŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽAŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽU
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.
ADDITIONAL FEATURED ESSAYS
Bless Me Ultima - Character Analysis
A child is much like a far-reaching scientific experiment. Both are expensive and in constant need of attention. Nev
Bless Me Ultima
1) Bless Me, Ultima is fitting because the main character Antonio learns and is blessed by Ultima, a curandera. If I had
Bless Me Ultima
1) Bless Me, Ultima is fitting because the main character Antonio learns and is blessed by Ultima, a curandera. If I had
Bless Me, Ultima: Antonio
Antonio, as a young hispanic boy,about the age of nine, is constantly prodded by his parents to choose the type of lifes
Bless Me Ultima 2
Children believe what their parents tell them but as they get older they start to question that which used to be unquest
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