Angina Then & Now

Only 30 years ago the diagnosis of angina pectoris "was tantamount to the issuance of a death warrant." Today the panic associated with it has gone, and after 30 more years medical science may have reduced it to the status of an interesting rarity. So says famed Cardiologist Arthur M. Master of Manhattan's Mount Sinai Hospital in the A.M.A. Journal. Angina pectoris (literally, suffocating pain in the chest) is caused by sclerosis of the coronary arteries in a clutching, chronic form--less dramatic than the violent seizure of the heart attack, when a coronary artery actually shuts down.

The first warning signs of angina were often concealed from the doctor, only a generation ago, because absence from work for any reason usually meant loss of income. Treatment was not begun until too late. With the current emphasis on preventive medicine, this is no longer true.

Diagnosis is far more accurate nowadays because much has been learned about the variability of angina symptoms. These were formerly supposed to follow a rigid and classic pattern, with a viselike tight pain in the chest, radiating to the back and down the left arm, accompanied by fear of impending death. With the realization that one or more signs may be missing, doctors are diagnosing angina earlier and oftener.

Cocktails for Surgery. Improvements in treatment have kept pace. Amyl nitrite was formerly used liberally, and nitroglycerin only sparingly, as a last resort. Whisky was freely prescribed, and tobacco rigidly banned. Nowadays, Dr. Master notes, amyl nitrite is seldom given because it causes too general a dilation of the arteries. Nitroglycerin, on the other hand, is freely prescribed, not only after the onset of an attack but to head one off: "When activities known to precipitate an anginal attack are undertaken--coitus, walking uphill, walking after a meal, walking early in the morning, stepping out into the cold, or walking against the wind--the patient is urged to take nitroglycerin beforehand." This usually averts an attack, or greatly reduces its severity.

Patients used to be advised to move to a warm climate (on the theory that in cold temperatures tissues require a greater blood supply, which puts a strain on the heart). With better drug control, such moves are rarely advised now. Patients used to be subjected to surgery to remove part of the thyroid gland. This can now be done by simply swigging an "atomic cocktail" of radioactive iodine. Tobacco is no longer banned in all cases--"there is little point in forbidding a tense patient to smoke a little, if that serves to relax him." Also, "if one or two drinks a day serve to relax an otherwise apprehensive person, it would be unwise to prohibit them." But the patient must not drink heavily because that--it is now known--adds to the burden on the heart instead of decreasing it. Angina patients are now also allowed to fly, in preference to a longer, more fatiguing surface journey, thanks to the development of pressurized cabins and anti-motion-sickness pills.

Unparalleled Surge. Major surgery to correct other disorders was formerly denied angina victims until they were in virtually hopeless condition because it was considered too dangerous. But now, improved anesthesia and easy transfusions have put angina patients on a par with others in surgery.

Finally and most important, arteriosclerosis--the basic cause of angina--is now recognized as a disease like any other, and probably the result of a derangement in fat metabolism. This realization has brought about "an unparalleled surge of research in human and animal biochemistry. A renewed confidence has been born as the result of a better understanding of arteriosclerosis and a hopeful approach to its prevention and cure." The designation "chest pain" or "coronary disease" is no longer a stigma, Dr. Master notes. In fact, he adds tartly: "To discuss one's electrocardiogram is as acceptable as to discuss one's analyst."

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