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Angina & Other Heart Conditions,

There are many heart problems related to AS ! Cardiovascular manifestations include angina, pericarditis, ECG conduction abnormalities, and rarely aortic insufficiency.

Myocardial Infarction and Angina

In this section, we will deal with problems associated with blockage of the coronary arteries that supply blood to the heart muscle itself. There are a number of different terms that refer, for the most part, to the same underlying disease process.

1. HEART ATTACK = MYOCARDIAL INFARCTION = MI (this describes the complete blockage of a coronary vessel). With total blockage of blood flow the heart muscle will die resulting in a myocardial infarction.
2. ANGINA: chest pain as a result of the heart's inability to receive adequate blood flow (and oxygen). When the blood flow is COMPLETELY interrupted, myocardial infarction (heart attack) results.
3. CORONARY ARTERY DISEASE: describes the problem more specifically. When the coronary arteries have become narrowed they are considered "diseased." This occurs through a gradual occlusive process in the arteries known as atherosclerosis. Patients with coronary artery disease are at risk for MI.

RISK FACTORS FOR CORONARY ARTERY DISEASE

1. Smoking
2. Obesity
3. Diabetes
4. Hypertension (high blood pressure)
5. Family history of heart attack
6. High blood cholesterol
7. Prior MI
8. Low HDL lipoprotein level

Common symptoms of acute MI (or angina) include sub-sternal (mid-chest) discomfort. This is usually a dull pain that may radiate to the arm or jaw. Associated symptoms are shortness of breath, sweating, and nausea. Typically, the pain is provoked by exertion. Approximately 10% of patients having an MI may have few symptoms ("silent MI") or none at all. This is more common in patients who have a history for diabetes.

Cardiac symptoms can vary in some patients. They may experience either "chest tightness", upper abdominal pain (that radiates pain to the back), and/or sudden sweating with or without shortness of breath. For this reason, a physician's medical evaluation should always be the rule.

Evaluation for the symptom of acute chest pain will include:

• ECG
• Chest x-ray
• Blood tests (i.e. blood counts, cardiac enzymes, blood chemistry, and coagulation profile)
• Observation on a cardiac monitor
• The patient who is at risk for coronary artery disease, but is not currently experiencing chest pain, might undergo an evaluation that would include:
• Stress test (treadmill exercise test)
• Thallium scan of heart (nuclear scan)
• Cardiac catheterization
• ECG
• Blood cholesterol test
• Chest x-ray

Treatment of acute chest pain, when it is secondary to coronary artery disease, warrants hospitalisation and control of pain with medications. Nitroglycerin is a commonly used heart medication that improves blood flow through the coronary arteries. In the hospital this may be given intravenously.

Treatment of underlying health problems known to contribute to coronary artery disease (diabetes, high blood pressure) is also important. Emergency management of acute MI has changed with the advent of thrombolytic agents that dissolve blood clots.

Advanced cardiologic procedures such as angioplasty (PTCA) can increase survivorship and limit heart damage in some select cases. Studies show medical outcome improves substantially the sooner expert medical care is rendered (after the onset of chest pain). The cardiologist is the expert in the management of this problem.

HOW TO LESSEN YOUR CARDIAC RISK

1. Stop smoking (if you already smoke)
2. Observe a diet that is low in fat and cholesterol (the cardiac diet).
3. Regular exercise within tolerance levels.
4. Keep body weight within recommended levels (see HEALTH & DIET FILE under obesity and weight loss. Refer to the manual for a height/weight chart.
5. Close control of blood pressure is necessary in those with hypertension.
6. Have an annual physician examination that includes a ECG and cholesterol (and lipoprotein) testing.
7. Close control of diabetes.

Recent evidence suggest that daily vitamin E, in doses of 200-400 I.U., can decrease the level of LDL (bad cholesterol) and decrease the effect cholesterol has on the coronary arteries. This has been touted to decrease the risk of coronary artery disease by 40%. Long-term studies on the daily use of larger doses of vitamin E need to be performed to make sure vitamin E has no latent adverse effects.

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