Angina: Don't Take It Lightly

Heart Disease (Coronary Artery Disease) Slideshow

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

I'm a fan of "Pardon the Interruption", a talk show on ESPN, only because I enjoy the wit, wisdom and camaraderie of the hosts, Tony Kornheiser and Michael Wilbon. Unfortunately for me and more unfortunately for Mr. Wilbon, instead of being in front of the camera, he was underneath one in a heart cath lab undergoing an angioplasty to open a blocked blood vessel to his heart.

Heart disease remains the number one killer in the United States, and each case is a potential failure because risk management wasn't aggressive enough. There are five major risk factors for heart disease:

• smoking,
• high blood pressure,
• high cholesterol,
• diabetes, and
• family history.

You can't do anything about the genes you inherited, but the other four need life long vigilance to minimize the risk of not only heart attack but also stroke and peripheral vascular disease. All risk factors involve narrowing of the arteries that supply blood to the body and the consequences that occur when organs don't get enough blood and start to fail.

But, back to the heart. It is a muscle like any other and needs blood carrying oxygen and glucose to contract and squeeze and send blood to the rest of the body. When one of the blood vessels to the heart narrows and not enough oxygen gets delivered, that part of the heart gets irritated and begins to ache, no different than arms that get sore from lifting or legs that hurt from running. Heart pain is called angina, and while you can touch an arm or a leg and feel where it hurts, angina can be trickier. It may be felt as chest pressure, indigestion, jaw, or arm ache - or nothing at all.

Angina is a warning sign that a disaster may be on the horizon. The narrowing of a blood vessel to the heart occurs because of plaque or cholesterol buildup. When the plaque ruptures and completely blocks the artery, no blood will flow to parts of the heart muscle, and it begins to die. The clock starts when this occurs, and each minute that passes means that more heart cells die. When a patient gets to the hospital, the goal is to open the blood vessel with an angioplasty within 90 minutes.

There are a few obstacles to prompt treatment. The patient has to get to the hospital, the doctors and nurses need to make the diagnosis, and the hospital has to have a cardiologist and team available 24 hours a day and a heart cauterization suite to do the procedure. It's easier to play prevention than manage disaster.

I'm hopeful that Mr. Wilbon recognized that chest pain is not normal and had an angioplasty relatively electively, instead of in the midst of a heart attack. I hope that, like David Letterman and his bypass surgery, it will increase awareness for heart disease and stroke prevention. I hope that when he returns, Mr. Wilbon reminds us about his heart issues and keeps the number one killer in the US in the spotlight.

Reference: TransWorldNews.com, Tuesday, January 29, 2008; "Sports Columnist Michael Wilbon Suffers Minor Heart Attack."