DIFFERENT INTERPRETATIONS OF CORONARY SYMPTOMS AFTER A HEART ATTACK
Patients who have sustained a heart attack naturally assume that any complaints in the heart area are related to their myocardial infarction. However, dyscardia and other complaints caused by different parts of the body (such as the vertebral column) can be projected onto the heart after the heart attack just as prior to it, even in healthy persons. Heart attack patients understandably become more sensitive to their heart with the good intention of taking better care of it. As a result, they tend to worry about minor pains which they would have barely noticed earlier. Many symptoms, completely unrelated to the heart, are then thought to be caused by it. Fortunately, this stage is of short duration in most cases because the more time passes after the heart attack, the more confidence the patient gains and the less concerned he becomes about minor pains. The patient should consult his physician if regaining his emotional balance takes longer. By means of exact descriptions and the self-testing methods explained on p. 34 the patient can learn to distinguish a true angina pectoris from a false one, dyscardia.
True angina may be reduced, be the same, or be more pronounced after a heart attack.
Mr. A.D., 50 years of age, came to our clinic one day riding his bike. He had sustained a heart attack 10 weeks earlier, but now was able to attain 100 watts on the bicycle ergometer and while walking. He has only one complaint which is that he still is made aware of his heart after meals, on cool mornings, after rapidly climbing stairs, when the weather changes, and when he is upset or under time pressure.
What usually happens after a heart attack? Will one continue to have heart problems? What can be done to prevent them? Angina pectoris, which occurs rarely, lasts only 2 to 5 minutes, and disappears when standing or sitting down and can be treated successfully with drugs such as nitrates and beta blockers. The nitrates should be taken in a dose sufficiently large to prevent attacks of angina pectoris. For quick relief in cases of emergency or unexpected increase in chest pain, ask your physician for a special pill rapidly absorbed from under the tongue or a spray. You should always take these nitrates along with you wherever you go. Moreover, you should ask what the maximum dose is in order to know how much of the drug you can take on a day when the pain is particularly severe.
What should you do if the chest pains do not become milder or less frequent, but instead increase in frequency, duration and intensity? What should you do if you suddenly feel pain after the slightest physical exertion? You are probably in a new phase of your coronary heart disease and you should immediately inform your physician about it. He must have a detailed description because he cannot know what you do not tell him. You should take your new symptoms seriously and act immediately to prevent re-infarction. We cannot emphasize this point strongly enough. An apathetic attitude characterized by the remark "what came up by itself, will disappear by itself could have grave consequences for the patient. If the complaints are particularly frequent and severe, and cannot be controlled with the drugs discussed in the chapter on long-term drug therapy, then a coronary angiography must be performed. This examination will make it possible to decide whether a by-pass operation is necessary. Over 90% of those who are operated upon are free of symptoms after surgery.
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