Sudden onset of angina

[AshokS]

I am a 39 year old man, had high BP detected since age 18, but under control with medication. In early 30's, my cholesterol was detected to be borderline but I did not pay attention towards reducing it. I have been physically active very regularly since teenage. 2 years back, in an executive health checkup including ECG and stress TMT, followed by CT Angiogram, it was detected that my LAD may be 40-60% blocked. It was a wake up call and I adhered closely to dietary and life style changes + inclusion of statin (5mg per day). The lipid tests have been favorable since then.

Over last 3 months, I increased my exercise - brisk walking - aggressively from 4-5 miles to up to 25-30 miles (on weekends, with around 5 miles per week day). I was doing quite well with no symptom of angina. Then, I was hit by a viral infection that kept me down with fever and chest congestion for around 7-10 days. When I resumed, I was hit so massively by angina that I had to walk back home after 1 mile. Isosorbide dinitrate just exploded my head with thumping headache. My cardiologist has put me on Nicorandil, which definitely helps, but I am still quite far from my earlier fitness levels. The gentle slopes which I could walk up with ease a few weeks back, now make me slow down and pace myself to avoid angina. Any thoughts as to why this sudden onset may have occurred?

[CCFHeartMD19]

Hello there,

It is hard for me to give you an accurate assessment of the situation without meeting you and reviewing your entire history in detail but I can give you some general advice.
There are lot of things both in terms of lifestyle modifications as well as medications that you have been on.
It is hard to comment as to why you had an episode of breakthrough angina but one thing is for sure- If you continue to have anginal episodes with exertion, you need to go back and see your cardiologist. It may be that you need a stress test or a cardiac catheterization for further evaluation of your symptoms.
Certainly, you have  several risk factors and most importantly you have established coronary artery disease, which was in the moderate range before.
I would recommend that you take the symptoms seriously and  see  your cardiologist as soon as possible for further evaluation and management.

Hope that helps.
CCFHeartMD19

[AshokS]

Thanks a lot for your input.

Yes, I had raised this to my cardiologist after getting the Lipid and Liver Function Tests done. Based on this, he has recommended Nicorandil (5 mg each dose two times day). It has definitely helped control the angina better and that too, with very little headache.

I am also intensifying (following even more religiously) the lifestyle modifications.

But I keep on wondering, whether this (as you put it - 'breakthrough') angina was a fallout of the viral infection OR it was brought on by the relative lack of activity during the infection period.