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Angina
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Angina

Can the pain/discomfort of angina last virtually all day long?
Thanks
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367994_tn?1304957193
Angina is the result of a decrease of blood flow to the heart cells.  Stable angina results when there is exertion, stress, fatigue, and anger and subsides with rest or relief from aggravating factors.
Unstable angina occurs with or without exertion and often the result of a clot or plaque breaking off and causing a decrease of blood flow to heart cells.  If there is prolonged angina, it may indicate a very serious condition.  Heart cells may become necrotic (dead) and heart failure..
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Yes this is possible if the heart walls are too thick and the blood supply has been outstripped.
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237039_tn?1264261657
Unfortunately, in my case, yes they can last all day, and day after day.  But a lot of my angina is actually coronary artery spasms.  I have had as many as 12 a day.  The pain from these is very much like the chest pain I had with my heart attacks, and that's what scares me the most.  Take care, Ally
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976897_tn?1379171202
If you are diagnosed with stable angina, and you experience pains/discomfort during exertion but not at rest, cardiologists label you as 'controlled'. If however, the condition worsens and angina is present even at rest, this is something which needs immediate checking. This is no longer stable. When you feel pains, your heart is telling you there is a problem.
What recent tests have you had? What medication are you on?
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370181_tn?1408130715
Thanks everyone for your quick replies, I really appreciate it. I am so scared right now, I'm probably going to become one of those really annoying, constant, "what if" posters! I'll beg your forgiveness, and patience, right now. LOL
As a couple of you know, I'm a CL over on the Anxiety Forum, and I'm there for obvious reasons...........PTSD and panic disorder compounded by health anxiety, most especially my heart. If you ever get a chance, check out the forum and you'll see that a very great many of our posters are freaking out about their hearts. Any idea how many people I have sent to YOUR forum? Hundreds!
One of the nastier side effects of anxiety/panic is that it causes chest pain. Thousands of people having panic attacks go to the ER because they KNOW they're having heart attacks. Accepting that it's JUST panic is incredibly difficult because the pain is very, very real.............it's just not coming from our hearts but rather our brains.
Since last Friday when I had the abnormal EKG, I have been in a constant state of extremely high anxiety. I have always been hyper-vigilant about each and every pain or odd sensation I get, but it's totally our of control now. Last night I had a fleeting pain in my right elbow, lasted all of 2 seconds, but of course it was a sign of a heart attack to me and soon I had hyperventilated myself into a panic attack!
I have GERD and a very, very bad habit of not eating in the morning and often don't eat anything all day, until dinner. That began way back in high school, 40 years ago! Instead, I have coffee and cigarettes. (Don't worry, I've been wearing my "dunce" hat for years) I also have severe psoriatic arthritis. It's a worse kind than OA, more like RA but not as deforming. I have lived with the chronic pain of that since it was dx'd when I was 20, and it's just gotten worse as I've gotten older.
When I first wrote to you folks, I explained about the huge amount of stress I've been living with for the past couple of years, and REALLY bad this past year since my husband got laid off LAST May. I don't need to tell any of you what having your income drop by $3000 a month can do. It creates a tsunami of stress. I suppose one could easily add depression to my list of ailments. I've resisted taking an antidepressant as I had a horrible experience with them once and it's soured me on them ever since.
I am sorry about the length of this post.............even I don't get the point of all this rather useless information.
Nine years ago when I had the heart cath done, I remember the doctor talking to me about the degree of plaque buildup in some artheries, but I swear to God I have absolutely no memory of him telling me I had angina! NONE. Last week, before I saw my doctor, I dug out what reports I had from that time to take with me. As I reread them, imagine my shock when I turned a page over and saw that he had written I had angina! How does one simply "forget" they've been dx'd with angina?
This cardiologist I saw is one of the best in the Seattle area and the only thing he did was put me on Atenolol and an 81mg aspirin. Naturally he told me to quit smoking, but his parting words were, "I hope the next time we meet is at a social event." He didn't even tell me to come back for any kind of follow up. How was I not to assume that things were basically OK. That I obviously needed to be concerned about the plaque and that I really needed to quit smoking, but I didn't leave there saying "Oh dear, I have angina and I need to learn more about this and what to watch out for." Which with MY anxiety, I would have become an expert on angina! And he most definitely did not perscribe nitro for me!
I have an annual physical without fail. Because of my smoking, a chest X-ray was standard, I had a PAP and a mammo, bloodwork..........guess you'd say the "whole nine yards." Aside from some cholesterol issues and one slightly abnormal glucose result, everything has come back fine. I have spoken to my doctors about my panic, and the chest pains I get during an attack, and the pain/discomfort in my chest from the GERD, but not one of them has sent me for any cardio checks. Either I've been unfortuante to have been under the care of total morons, I have felt confident that if they thought there was a cardiac issue, they would have referred me.
I am trying desperately to think the same about this recent event with the abnormal EKG. If my doctor had thought this was really bad, that it needed immediate attention, the hospital is right across the road and there is a three story building filled with nothing but cardiologists. Why would she not have sent me there right then? Why would she make me an appt. with a cardio nearly three WEEKS later? I have faith in this doctor and also can't help thinking that it would be HER arse, and HER license on the line, if she had failed to get me help. She has the clout that if she thought I needed to be seen by a cardio immediately, it would have happened. Or she would have admitted me to the hospital. I'm sure it must seem like a slim thread and stupid rationalizing on my part, but why would she risk so much if this was not an emergency?
Between my anxiety, my GERD and my arthritis, I really don't even know for sure what angina feels like. The discomfort I felt most of the day yesterday felt more like my anxiety/GERD type pain and while I kept staring at the bottle of nitro I now carry around constantly, I never thought to take one. I was so anxious, so nervous, I was totally convinced it was my panic doing this to me, but now there is the element of no longer being convinced. Which only breeds MORE panic. More stress.
I took an extra Xanax last night because I was exhausted from the worry and within 20 minutes I felt fine. No more pains, no more stress.
I'm pretty sure by now you're all saying "I wish she would just go away!" and lucky for you, I must get ready for work, but unfortunatley for all of you, I have much left to ask. As I said earlier, I'm no doubt going to become one of those posters that you all roll your eyes and think, "Oh Lord, SHE'S back!"
Some of you asked me quesitons which I was too busy flapping my mouth to answer.
To ed34, there is a list of my meds that I sent to kenkeith in another post. I'll write them down again unless you've gone hunting! LOL
Again, I do sincerely apologize for rambling on and on. I think I do it because I'm scared and it helps me to just talk. You probably wish I'd just go in the closet and talk to myself if that's the case.
I will be back, so if you'd care to draw straws as to who has to respond to me, now is your chance!
Warmly, but with some embarrassment
Linda


              
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237039_tn?1264261657
Feeling better now?  LOL  Sometimes it helps to VENT.  To vent: Would that be to blow or suck?  Ally
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367994_tn?1304957193
I had silent ischemia, and then a silent heart attack. My current medication is coreg (beta blocker) and it can reduce the frequency of silent ischemia and of myocardial infarction. With this medication about 80% of the patients affected, unstable angina will be converted to the stable form of the disease. If symptoms persist coronary angiography is URGENTLY indicated, to allow the selection of PTCA or aortocoronary bypass surgery according to the findings.

It seems if one has unstable angina for a day, there would be serious damage to heart cells, therefore, it should be treated.  Whether it is silent ischemia or not so silent ischemia represented by unstable angina, the consequences are the same...damaged heart cells.
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237039_tn?1264261657
But I have unstable angina and have been hospitalized a few times only to be sent home with meds.  Only recently has there been any discussion of CABG.  At that I went AMA.  I'm still out on how I feel about that.  Thanks, Ally
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976897_tn?1379171202
I was told that spasms are variant in different people. It ranges from around 70% to 95% constriction. From the level of my angina, it was definitely a lot less than 95%, probably around 70-75%. With an EF of 70% I don't think tissue damage is likely?
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367994_tn?1304957193
I believe there is heart cell damage when the system sends the message of not getting enough blood/oxygen (angina).  Franky, EF is often irrelevant as some people are better compensated and some do well with an EF below normal.  I think it is safe to say anytime there is angina there is a lack of blood flow to heart cells and lack of blood flow will damage heart cells. Brief episodes of angina may only kill a few heart cells at a time, but overtime there will be heart failure if not treated...same with the brain.   Additionally, lack of oxygen to heart cells can be due to hypoxia and the EF can be normal.

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976897_tn?1379171202
"Brief episodes of angina may only kill a few heart cells"

This is turning into an interesting discussion, however I do believe that statement is not really accurate. I was offered a procedure two years ago where some heart tissue would be destroyed by laser and stop the feelings of angina. I immediately questioned how I would know if I had angina, not being able to feel it, hence not knowing if I am damaging my heart. I was told that angina does not cause any permanent damage, only reversible. The heart cells recover quickly inbetween attacks of angina. The only cause of heart tissue death through blood flow is if the flow is shut off totally (heart attack). This is why acute heart attacks are the real culprits, whereas other heart attacks can be caused by 98% blockages. The heart gets very distressed in mild heart attacks, but is reversible. Acute heart attacks kill cells in around 30-40 minutes if the blockage isn't removed in that time.
Well that's what I was told two years ago. Maybe research has found that this is not the case anymore.
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367994_tn?1304957193
There is validity or logic in what you state, some cells may be in a reversible state other heart cells may not be in my opinion. The degree of hypoxic injury depends not only on the intensity and duration of the hypoxic event, but also on the level of cardiac tolerance to oxygen deprivation. I don't believe all heart cells have equal tolerance.

I am suggesting over a period of time with spasms or ischemia from blockage causing angina some heart cells will have much less tolerance to oxygen deprivation. But from an acute heart attack, the cells can be stunned and if quickly treated the cells can be revitalized.

Heart cells may be in hibernation from hypoxia, and restoration of a good blood supply does not always restore complete functionality. There can be hypokinetic muscle of a heart wall from lack of oxygenated blood that does not fully recover. I had an ischemic heart attack wih hypokinesis of an area that required very little heart wall movement normally.  So complete recovery of all heart cells isn't of much significance.

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976897_tn?1379171202
Yes I think I agree with the logic in what you say. If angina is present with no time for recovery, i.e. 24/7 then more and more damage will occur and eventually likely beyond recovery. I suppose that's why more aggressive medication is given with severe angina, or when patients have angina at rest, which is in turn why they recommend immediate surgical intervention if the medication is no longer working.
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237039_tn?1264261657
I have to agree with Ed on this.  I have suffered with unstable angina for the past 4 years now, and have not had to have any intervention since 2006.  In the hospital I was always told the same thing, "The blockages are too small".  Only recently (the past year) the episodes of angina/spasms have increased in severity, intensity & occurrance and now I am being told of another blockage that has been found.  My main concern is the angina/spasms I get that wake me up.  I can't tell you how many sleepless nights I have had.  Today has been good so far, but what does tomorrow hold, and what is happening to my heart?  I had only 1 attack last night and only 2 minor attacks today.  This has become a way of life for me and I just can't accept that this is the way it should be!!!!!!!
And further to that, I am tired of ending up in the ER only to be sent home with meds after a few tests and days.  I want some real answers and I am not getting them.  Why am I suffering with this?  That's all I need to know to start. I usually get a blank look when I ask this.
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976897_tn?1379171202
I can see both sides of the coin here and it certainly is interesting. People who have suffered many years of angina symptoms with slight exertion seem to go damage free, according to appropriate tests. I personally think that it may be a perception of what angina actually is. The term angina is certainly used by experts to describe insufficient oxygen reaching a given area of the heart. But, in bodily terms, to the individual, what is really happening physically. Maybe, now I'm simply hypothesizing here, but maybe someone has already turned in into theory, maybe the feelings we experience commence as a warning sign, rather than a sign that something bad is already happening. I realise some people have no signs at all (silent) but let's stick to mr and mrs average now. Maybe when a blockage reaches 70% or just over, the warning signs of angina start in most people, 'before' oxygen becomes so low as to cause harm. As the blockage increases, then the damage zone will obviously be reached, but with medication this should be greatly reduced, hopefully enough to keep it in the warning zone. I have no idea how this mechanism could work, so for goodness sake don't go technical on this hypothesis and ask me questions lol.
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370181_tn?1408130715
I have been reminded that it is now time for me to choose a "Best Answer" to my post.
I can't and won't do that.
There is no way I could choose a "best answer" because ALL of you gave me great answers, support, advice and encouragement.
I learned something from what each of you wrote.

MY choice is thank ALL of you, from the bottom of my wonky heart, for your replies in my time of crisis and fear. You're ALL the best!

Warmly,
Greenlydia
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976897_tn?1379171202
Dont worry, Im not here for ticks, starts, badges, medals, bonus pay. I'm here to hopefully help someone.
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