American Medical Association Family Medical Guide - American Medical Association [318]
Although angina is usually a symptom of heart disease, it can also result from other health problems. For example, a defect in the aortic valve may reduce blood flow to the coronary arteries, thereby reducing the supply of oxygen to the heart muscle. Arterial spasm, which causes sudden temporary narrowing of a coronary artery, can also cause angina. Severe anemia (see page 610), which may decrease the supply of oxygen to the heart, is another possible cause of angina.
In some people, symptoms of congestive heart failure (see page 570) such as shortness of breath; persistent coughing up of sputum; or swollen legs, ankles, and feet are the first signs of heart disease. Heart failure occurs when the heart muscle is too weak to pump an adequate supply of blood to body tissues. Occasionally, symptoms of conditions that do not involve the heart and blood vessels, such as indigestion or gastroesophageal reflux disease (GERD; see page 750), can be mistaken for angina. If your doctor determines that you do not have heart disease, he or she will perform additional tests to find the cause of your symptoms and provide appropriate treatment.
Diagnosis
If you have symptoms of heart disease or if you think you may have angina, see your doctor as soon as possible. He or she will examine you and may recommend that you see a cardiologist, a doctor who specializes in treating heart problems. To determine the condition of your heart and blood vessels, the cardiologist will probably perform one or more of the following tests:
Electrocardiogram
An electrocardiogram (ECG) measures the electrical activity of the heart muscle and enables the doctor to detect a number of heart problems, including early signs of heart disease such as arrhythmias (abnormal heartbeats) or episodes of ischemia (inadequate blood flow to the heart). During an ECG, electrodes are placed on specific areas of your chest, arms, and legs, and a machine records the electrical activity of your heart. Continuous ECG monitoring is done using a portable device called a Holter monitor. The monitor, which you wear around your neck, over your shoulder, or at your waist, records an ECG over a period of 24 hours or longer.
Exercise stress testing
Exercise stress testing measures the electrical activity of the heart with an ECG while you walk or run on a treadmill or ride a stationary bicycle. This test helps evaluate the severity of heart disease and the ability of the heart to respond to an inadequate blood supply. If this test reveals arrhythmias or ischemia, the doctor may recommend drug treatment. If the ischemia persists even with drug treatment, the doctor may recommend a coronary angiogram (see right) to determine if angioplasty (see page 565) or bypass surgery (see page 564) is needed to restore blood flow to the heart. The test may also be performed before or shortly after a person leaves the hospital after a heart attack to help determine how well he or she is doing and whether the ischemia is continuing.
Electrocardiogram
MY STORY Heart Attack
I had been having chest pains off and on, and was feeling anxious and having trouble sleeping for a couple of months. I thought it was just heartburn. The idea of heart disease didn’t occur to me because I assumed it happened mainly to men. I hadn’t had a physical exam in a few years. Then one morning, while I was making breakfast at my son’s house, the pain started again. This time it got really bad. It hurt in the center of my chest, as it usually did, but then the pain and pressure spread to my left arm and jaw. I broke out in a cold sweat and started feeling light-headed and nauseous. While I was telling my son how I was feeling, I became short of breath.
My son seemed to know what was happening right away. “Mom, you could be having a heart attack!” he said, and ran to the phone and called 911. Then he gave me an aspirin tablet and told me to chew it up and swallow it. The paramedics came about 10 minutes later and attached