Angina – Life with a Chronic Illness

Broken but ok

Broken but o.k.

Simply stated, the word BROKEN, in my humble opinion, best sums up the world of chronic angina.

Broken, but o.k.

One is not the whole person they profess to be, not the person they once were, nor the person filled with hope and dreams when your life is affected by chronic angina.  You know vehemently and dolefully that you have limitations.  You are “broken”.

You become the mechanical wind-up toy that no longer springs ahead once the key is turned.  “Your get-up and go has truly got up and went.”

Let’s get real.  Chronic pain exists everywhere from chronic back pain, fibromyalgia, headaches, depression, chronic joint pain, gastric pain – the list is endless.  I would guess each and every human being can relate to my analogies.  Although this post deals with chronic pain associated with angina.  I do not want to lessen the pain or importance of any other medical condition or struggle.

Chronic pain is chronic pain, no matter which illness or disease process chisels away at our human form, making us the person we are today.

We all fight some demon every day.  I live with angina every day.  I stay “normal” by doing my best to make a difference in someone else’s life.    I remain positive.  There is always an advantage to every disadvantage and I find it.  I do not fully understand how it helps me, but it does.  Perhaps it gives me self-worth at a time when I feel I cannot live up to my full potential.  I have some limitations.

I write this so others can relate to my words and life.  Writing reflects feelings. Writing shares emotion.  I want others to know that I feel what they feel.  We are all here for each other.  I don’t want anyone to have to fight alone.

I want to share what angina is all about.

Angina has a way of suddenly reminding you that you are “broken.”  The chest pain and heaviness, along with the shortness of breath and fear, arise at the most inconvenient times.

Angina is chest pain or a sensation of pressure or heaviness that occurs when the heart muscle is lacking adequate amounts of oxygen. Classically, it is a crushing pain behind the breastbone in the center of the chest, brought on by increased activity and relieved by rest. It may at times radiate to the left arm, neck, jaw, left chest, or back. It is frequently accompanied by sweating, palpitations of the heart, and generally lasts a matter of minutes.

It is not unusual to hear of similar symptoms in disease processes such as esophagitis, gall bladder disease or other gastrointestinal illnesses.  It tends to develop in women at a later age than in men.

Stable angina is a more predicable chest heaviness and discomfort that occurs with increased physical activity or during emotional episodes that is relieved with rest or nitroglycerin.

Unstable angina is a more alarming type of angina that signals an impending heart attack.  This angina is somehow different from any previous episode of angina you may have experienced.  It occurs suddenly and without any increased exertion.  It is more frequent and more intense.  It is not relieved by nitroglycerin.  It requires the immediate and urgent attention of medical care.  Angiography may be performed if symptoms do not improve to help determine if coronary artery bypass surgery or angioplasty is necessary.  Ultimately, treatment of the coronary artery disease is required.

Prinzmetal’s angina is chest discomfort caused by a spasm of the coronary artery that decreases blood flow to the heart. It is also known as variant angina.  This can occur at rest, when sleeping or when exposed to cold temperatures.  This type of angina may or may not be associated with coronary artery disease.

Angina is a symptom of coronary artery disease that may lead to a “heart attack.”  Coronary artery disease refers to blockages in the flow of blood in those arteries supplying the heart muscle itself – the coronary (heart) arteries.  Our heart can survive only a matter of minutes without adequate blood flow.  Our body can only survive minutes without the heart.

It is common for angina to occur with physical activity or exertion as well as at times of emotional distress, as this makes the heart work harder, requiring more oxygen.  Angina can also occur at rest if the reduced blood flow is severe.

When angina does occur, it may go away with rest.  If not the medication Nitroglycerin is taken to dilate the coronary blood vessels and thereby relieve the pain.  Angina is frequently worse after a large meal or in cold weather.  Sometimes you can awaken with angina after an emotional or bad dream.

The treatment plan for angina is dependent upon the stability and severity of the symptoms.  Key factors include the elimination of risk factors of coronary artery disease.  Blood pressure  and cholesterol levels must be maximized at recommended standards.  Smoking  must be eliminated.  Exercise  should be at the American Heart Association’s recommended levels of 150 minutes per week. Thirty minutes a day, five times a week is an easy target to keep in mind. You will also experience benefits even if you decide to split the time into two or three sections of 10 to 15 minutes per day.  Cardiovascular fitness can reduce the risk of heart attacks.  Some cardiac patients are fearful of exercise or exertion, thinking it may cause a “heart attack.”  On the contrary, more physical activity is recommended and aids in making the heart more fit and robust, improving blood flow. Weight must be at normal BMI.

There are definite triggers that bring on angina.  To live your best life, you should try to avoid these:

♥ Over-exertion involving physical activity – Be aware of the level of exercise that triggers angina.  Warm up and cool down.  You may take nitroglycerin prophylactically before you begin activity or simply avoid the activity altogether.

♥ Emotional Stress – Avoid situations that will create an emotionally packed event.  Avoid confrontations that provoke anger.  Stress-related issues may increase blood pressure and thereby increase the risk of a heart attack. Handle stress with care.

♥ Overeating – Avoid large meals and rich foods.  Adopt an eating pattern of frequent small meals.

♥ Cold – Avoid extreme temperatures and environment.

There are multiple medications that are effective for the control for the relief of symptoms of angina.  The most widely used medication is the nitrates, derivatives of nitroglycerin.  Included in this group are nitroglycerine and isosorbide.  There are also nitroglycerin patches that release a small amount through the skin and into the bloodstream during the day.  They act by dilating the coronary blood vessels so the heart muscle is able to receive adequate supplies of oxygen, preventing angina.  .

ACE inhibitors (Angiotensin-converting enzymes) are used to lower blood pressure and protect your heart by blocking the activity of a hormone called angiotensin II, which narrows blood vessels.  This is improves the flow of blood and the heart does not have to work so hard.

Another group of drugs are known as beta blockers. These block the activity of the beta receptors of the nervous system. The receptors cause blood pressure elevation, rapid heart rate, and forceful heart contractions. When these actions are reduced, the heart needs less blood, and thus angina may be decreased.

The newest group of medications for angina treatment – calcium channel blockers.  These medications relax the arteries, lower blood pressure and reduce the strain on the heart.

Both Plavix (clopidogrel) and Effient (prasugrel) as well as aspirin are common antiplatelet medications taken to prevent blood clots from forming and thereby reducing the risk of having a heart attack.

Ranexa (Ranolazine) is a relatively new medication to treat chronic angina.  It relaxes the muscles of the heart to improve blood flow and prevent angina attacks.

 Statins lower “bad cholesterol” (LDL) which contributes to the plaque build-up on the coronary arteries.  The statins also appear to decrease inflammation.  The American Heart Association list current statins used within the U.S.:

Atorvastatin (Lipitor®)
Fluvastatin (Lescol®)
Lovastatin (Mevacor®, Altoprev™)
Pravastatin (Pravachol®)
Rosuvastatin Calcium (Crestor®)
Simvastatin (Zocor®)

“Speak from the Heart”  is a website devoted to angina, stating: “With the right treatment plan and lifestyle changes, many patients with angina can get back to enjoying their lives.”  Here you will find volumes of information on angina – news and updates, patient stories, and tracking tools that will aide your physician in your diagnosis and treatment.

Cardiologists will generally recommend hard-hitting lifestyle and drug therapy before turning to more aggressive and invasive strategies with a stable angina diagnosis.  The alternative procedures for restoring blood flow include angioplasty (a balloon expanding procedure in the artery at sites of plaque), stenting (insertion of cylindrical tubes of metal mesh), and bypass surgery, increasingly through very small incisions.

Enhanced External Counterpulsation (EECP) is a non-invasive treatment of angina which has proven to be 90 to 95% effective.  EECP is a mechanical technique in which inflatable cuffs (similar to blood pressure cuffs) are wrapped around the patient’s legs. With the patient positioned on an exam table or bed, the leg cuffs are inflated and deflated with each heartbeat. This is accomplished by means of a computer, which is generated from the patient’s EKG.  The cuffs deflate with the beginning of each heartbeat. And inflate as the heartbeat ends. Treatments are an hour long and cover a period of 35 to 50 days.

Always, if symptoms of angina (chest pain) worsen, seek medical help.

Perhaps we are all just a “little broken.”  Even the velveteen rabbit was broken yet he was so loved.  It is a book loved by all.  The Velveteen Rabbit shows us that the reality of life is that we all lose small pieces of our selves along the way.  It is the subtle philosophy of “becoming real.”

“One small crack does not mean that you are broken, it means that you were put to the test and you didn’t fall apart.”
~ Linda Pindexter

Please take care of your heart. 

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6 Comments on “Angina – Life with a Chronic Illness

  1. Thanks once again for a very informative piece. Yes, we are all broken, and in our brokenness, we then find that we MUST become dependent on HIS strength, understanding, and comfort. THAT is what I think of when we are “broken.” I appreciate the wealth of information this piece presents. Thank you!!!

    • It is always a such a blessing to hear from you first thing every Sunday morning… thank you for being the BEST Theresa ever! Your comment is perfect! And this is what I think of when I think about broken:
      “Let us be bread blessed by the Lord, broken and shared, life for the world.
      Let us be wine, love freely poured. Let us be one in the Lord.”
      Blessings to you in your busy and beautiful week ahead.
      P.S. When are we leaving for India?

  2. Hi Sharon and thanks so much for such a comprehensive overview of angina. I’d add one important difference between the pain of angina and the pain experienced by those living with chronic back pain, fibromyalgia, headaches, chronic joint pain, etc. No matter how debilitating your back or headache or joint pain may be, you can be pretty sure it won’t kill you. The same cannot be said of chest pain.

    Chest pain is a whole new ball of wax. Each significant episode involves clutching your chest and wondering: “Is this something? Is it nothing? Should I call 911?” Anybody who’s already experienced a heart attack knows the terror and anxiety inherent in subsequent symptoms that might mean today is The Day that’s been dreaded since the first cardiac event. We know that the biggest heart attack risk factor, for example, is having already had one.

    As a person living with the daily pain of angina caused by Inoperable Coronary Microvascular Disease, my gut reaction to any especially severe pain tends to be: “Oh NO!!!!! Today is NOT a good day to have another heart attack!!!!” (And really, no day is a ‘good day’ to do that, right?! As you say, it always strikes at an “inconvenient time”!)

    Thus we live with both pain AND fear – a particularly brutal combination.
    regards,
    C.

    • Excellent comment, Carolyn… Yes, you took the thoughts right out of my head. I am always thinking: “Is this something? Is it nothing?” I am always “popping” another nitro, thinking please go away. Still, I like to think that I am merely a bit broken and I will be “o.k.” This is my “new normal.” And if I am not o.k., I have excellent cardiologists close by. I am fortunate in that aspect. Thank you, Carolyn.

  3. Pingback: Coronary Heart Disease | Find Me A Cure

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