Ask The Doctor

Keeping Angina Stable Forestalls Heart Attacks

Dear Dr. Garner,

I am having a problem with my heart. I am in good shape (or at least I thought so) and take pills for my blood pressure and also for chest pains I have had when exercising or at times when I get very aggravated.

Lately, the chest pain has become worse when I am just sitting and watching TV. My doctor says that my chest pains are serious, and he admitted me into the hospital for certain tests.

Could you please tell me if this is very serious?

Chest Pains in Cobble Hill

Dear Chest Pains,

Your doctor did the right thing by admitting you to the hospital.

Before discussing your problem, I would like to acknowledge a truly great Brooklynite who is being honored by CAMBA this week for all his efforts on behalf of Brooklyn.

Dr. Stanley Sherbell, chief medical officer of New York Methodist Hospital, Park Slope, is truly a unique individual. He and his wife Marie, a loyal fan of the Ask The Doctor Show and The Tablet, are an unbeatable team. Congratulations Dr. Sherbell on this well-deserved honor.

Now I would like to explain more about your condition, unstable angina, and how very serious it is.

Angina (ANN-JY-nuh) is a type of chest pain that occurs when there is not enough oxygen delivered to the muscles of the heart. This happens when the blood flow in the vessels of the heart is blocked by a plaque buildup. The symptoms include chest pain and strange feelings in the chest. You may experience shortness of breath, irregular heartbeat, neck and jaw pain, and even pain in the back.

Stable angina has a typical pattern. You can pretty much predict when the pain will occur.

It usually happens at a time when your heart is working harder and needs more oxygen. The pain goes away when you are at rest. It may continue without much change for years.

Stable angina can usually be controlled by taking medication, exercising and eating right.

Unstable angina is an unexpected change in the usual pattern of your angina pain. For example, having pain at rest is a sign that something new is happening, such as a buildup of plaque or increased blockage in the blood vessels of the heart. It is a warning sign that a heart attack may soon occur.

Unstable angina is a medical emergency. Your doctor will investigate your emerging pains with tests, such as an angiogram, or cardiac catheterization, which is performed by injecting dye into the arteries of the heart to look for vessel blockage. He may choose to open up the clogged vessels by angioplasty (physically ballooning out the narrowing), or bypassing the area with open-heart surgery.

Things that can change angina from stable to unstable include:
• Cigarette smoking
• Diabetes (uncontrolled)
• High cholesterol
• Obesity
• Physical inactivity
• Uncontrolled blood pressure

Keeping the above in check and changing your lifestyle can help forestall the conversion from stable to unstable angina.

In addition, there are medications your doctor may prescribe. The most specific medicine to treat angina is nitroglycerin. It helps to open up the blood vessels of the heart and make more oxygen available, reducing the chest pain.

The type of exercise that is most beneficial to improve angina is gentle and sustained exercise rather than intense short bursts.

In summary, unstable angina is a condition in which a patient experiences chest pain as follows:
– It occurs at rest or during minimal exercise and usually lasts more than 20 minutes.
– It is described by the patient as severe pain of new onset (within the past month).
– It has a pattern that is more severe, longer than usual, and increased in the number of times it occurs.

The key is to immediately inform your doctor about the change in symptoms and get to the emergency room as soon as possible.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.
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