The Cry Of The Heart

BFP Magazine

Cardio-vascular Health

Heart Attack, Anginal Pain

The Cry Of The Heart

By Dr. W. Gifford Jones

November 15, 1997

This year 750,000 North Americans will experience a heart attack. Half will not make it to the hospital. Others suffering from anginal pain are more fortunate. Listening to this cry of the heart (angina pectoris) can save your life.

William Heberden, an English physician, first described angina pectoris (pain in the chest) in 1772. It's difficult to improve on his literary eloquence.

He wrote, "There is a disorder of the breast with strong and peculiar symptoms considerable for the kind of danger belonging to it. The seat of it and the sense of strangling and anxiety with which it is attended may make it not improperly called angina pectoris."

Dr. Heberden detailed a typical attack. " They who are afflicted with it are seized while they are walking with a painful and most disagreeable sensation in the breast which seems as if it would extinguish life if it were to continue. But the moment they stand still all this uneasiness vanishes."

A further more frightening possibility was bluntly stated by the doctor. "If the pain continues, patients suddenly fall down and perish almost immediately."

But the cause of the chest pain and sudden death eluded physicians for nearly two hundred years. In 1872 Sir Lauder Brunton, a Scottish physician, came close to the answer. He discovered that nitroglycerine placed under the tongue relieved the pain.

Then in 1910 Sir William Osler, a founder of Johns Hopkins Medical School, reached the right conclusion. He determined that the heart's coronary arteries went into spasm.

But Osler couldn't prove his theory until the invention of the electrocardiogram (ECG). The ECG showed that angina was associated with abnormal electrical waves from the heart.

A heart that cries for help is a heart in trouble. It means that hardened atherosclerotic arteries are not bringing sufficient oxygenated blood to the heart's muscle.

But there is some good news for those who experience angina. The chest pain acts like a fire detector that warns of smoke before the blaze erupts. In this case the pain is so severe that patients must stop what they're doing. This inactivity allows time for more oxygenated blood to be delivered to the heart's muscle. Ô 0*0*0* Patients who suffer from an uncomfortable sensation in the chest, neck or arms may have angina. This is particularly true if pain occurs during periods of exercise, emotional stress or exposure to cold or after a heavy meal. Such symptoms should never be ignored.

How angina is treated depends on the severity of the problem. Not all patients with angina require a coronary by©pass operation.

For instance, the mineral, calcium, present in blood and body fluids, has the ability to cause arterial spasm once it's inside the arterial wall.

Calcium©Channel Blockers inhibit the action of calcium and keep the supply of oxygen flowing to the heart.

Another group of drugs called "Beta©Blockers" help to lower the heart's demand for blood.

Nitroglycerine, the safe©cracking explosive, increases the blood flow to the heart by stimulating coronary vessels to dilate. It also relaxes vessels in other parts of the body thereby lowering blood pressure.

But patients who have been prescribed nitroglycerine tablets often forget to take them. This may result in worrying chest pain. It's known that angina patients tend to decrease their level of activity according to the number of attacks they experience.

Recent studies show that nitroglycerine patches such as "Nitro©Dur" offer significant advantages over oral medication. Nitro©Dur has five different strengths and the doctor determines the proper dose and the number of hours the patch must be worn. Most people use it for 12 to 14 hours a day and remove it during the night.

The patch is also helpful for patients who require other drugs. Nitroglycerin delivered through the skin won't interact with medication in the stomach. And there's less risk of stomach upset.

A recent study presents an important argument for using the patch. Over 4,400 patients suffering from angina were given NitroªDur patches. Researchers found that this technique improved their quality of life. Patients simply did not forget to use the patch and participation and enjoyment of social activities was greatly improved. Moreover the patch delivers a continuous and even dose of nitroglycerine to the narrowed coronary vessels ensuring the patient a continuous protection throughout the day.

Be a wise medical consumer if you experience the "cry of the heart". Seek medical attention. A major obstruction of the left coronary vessel can cause sudden death. In this case a coronary byªpass operation might prevent this calamity.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: He can be reached at

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