The matter of the heart
The seasons, in differing ways, will detect early signs of angina and heart disease.
The sight of an elderly person on a cold, windy day, taking an inordinately long look at a shop window while climbing a hill, is often the first sign that their treasured old spouse or parent is beginning to suffer from angina.
In the summer, the initial evidence of a narrowing coronary artery may be uncovered by a usually inactive, officebound wage slave taking part in holiday exercise. In my Norfolk practice, pulling a boat out of the water was an occasional precipitating factor, but a strenuous tennis match, or even gruelling, unaccustomed golf, can uncover previously undetected heart problems.
The pain of angina arises because narrowing of the coronary arteries deprives the heart muscle of an adequate supply of oxygen. It varies in nature and severity. It is not a sharp pain, but usually a crushing, squeezing tight one, felt in the chest behind the breast bone or upper abdomen. The pain often radiates down the left arm or up into the neck or jaw.
If the pain is only occasioned by a temporary lack of oxygen to the heart muscle, it will pass off after rest, or if someone takes the appropriate pill or spray to dilate the narrowed artery. If the artery has been entirely blocked, starvation of the muscle of the oxygen carried in the blood will cause lasting damage to the patient’s heart. They will have then suffered a heart attack and will need immediate treatment and hospitalisation.
A word of warning. Women as well as men suffer from coronary arterial disease. In women, coronary disease is harder to diagnose.
The pain is more likely to be upper abdominal rather than chest pain, and may therefore be attributed to indigestion.
Doctors, when called to see patients who are complaining of symptoms suggestive of angina or a heart attack, look around the bedroom to see if there is any evidence of indigestion medicine.
Early diagnosis and assessment of the coronary arteries is arguably more important in women than in men, as operative intervention is more difficult. The heart is smaller, the arteries narrower and, it seems, perhaps mistakenly, that more of the arteries are affected.
The hazards of exercise, especially swimming, after a heavy meal were well appreciated by earlier generations, but later trivialised.
In the past forty or fifty years, the changes in circulation that cause the occasional disaster – of a happy holiday diner, who ends his or her meal by diving into a relatively chilly pool – are now better understood.
The digestion of a heavy meal makes demands on the blood supply and takes an inordinate amount of it away from the coronary circulation for the digestive tract. This simple redivision of available oxygenated blood, and its seizure by the upper gastro-intestinal tract, is graced by the name splanchnic steal.
A vigorous game of rounders on the beach, a race to the top of the hill, or some other sudden demand on the heart could be almost but not quite as dangerous as immersion in chilling water. Another example of the dangers of jolly holiday luncheons is in the incidence of heart attacks after postprandial activities in the bedroom. This hazard is considerably more evident if the partner is a recently acquired friend rather than a long term one.
On a similar subject, there is one aspect of the early diagnosis of coronary arterial disease in men that is little talked about, or perhaps less widely known. The first evidence of arterial disease is more likely to be otherwise inexplicable, increasing troubles with potency than anginal pains in the chest.
Any middle-aged man with otherwise unexplained increasing impotence needs full cardiac investigations. Penile arteries can be as occluded as coronary ones.