Versatile Angina

To the patient who has listened carefully to his doctor, angina pectoris (literally, strangling of the chest) means that because of exertion or excitement, his heart muscle is demanding more blood than its narrowed coronary arteries can supply. But it is not necessarily as simple as that, and angina can have some bizarre connotations, says Internist John Francis Briggs of St. Paul. The more doctors learn about the distressing symptom and its victims, the more complex angina becomes. To help get the next generation of practitioners started on the right track, Dr. Briggs lists 26 variations of angina in The New Physician, published for medical students. Some oddities:

P: Alcohol angina is not uncommon, results when a patient gets high enough to become "involved in emotional events" that he would have the sense to avoid when sober. Also, alcohol is often prescribed to relieve angina (it is little good except as a sedative), and "enthusiasm for the treatment" may become so great that the doctor winds up treating alcoholism, not angina.

P: Food angina can be equally bad: some patients, accustomed to pain after eating, develop a conditioned reflex so that the mere sight of food produces an attack; some, from fear of the pain, starve themselves into another kind of illness. P: Physicians can induce angina if, instead of relieving angina worries, they give the patient an exaggerated idea of the gravity of his condition. An electrocardiographic test or the sight of the consulting room may touch off an attack. "Treatment," says Dr. Briggs, loyal to his profession, "is very difficult."/-

P: TV angina is a new diagnosis. From the excitement of watching ball games and prizefights, "many patients [have] very severe seizures."

P: "Remunerative angina" results when the patient gets a reward for his illness. It may be only emotional-sympathy and pampering. Or it can be hard cash from insurance. (This form is becoming less common now that the companies have got wise and refuse to pay for it.)

Angina and pain are inseparable in the layman's mind. But to complete the confusion, Dr. Briggs lists a paradoxical angina sine dolore-angina without pain. The victim feels generally distressed and may get the sweats. Treatment is the same as for the viselike attacks: a tablet of nitroglycerin and rest.

. . .

With heart attacks and strokes causing about half of all U.S. deaths, eight eminent physicians (including five past presidents of the American Heart Association*) issued last week a check list of danger signals. Their belief is that while medical science gropes for definitive measures, attention to these signals "will prolong life for many at this time." First comes heredity: granted that "You are 'stuck' with your heredity," the group contends that if either a parent or grandparent died prematurely of arterial disease, "it is most important that you minimize the effect of the other factors." The others: being overweight by ten pounds or more, a high level of cholesterol in the blood, high blood pressure, smoking too much. For all these, the physicians' advice was the same: "See your physician."

/- But any layman can prescribe it: change doctors.

* The five: Chicago's Louis N. Katz, Cleveland's Irvine H. Page, Boston's Paul Dudley White and Howard B. Sprague, Manhattan's Irving S. Wright, along with Chicago's Jeremiah Stamler, Boston's Samuel A. Levine and Fredrick J. Stare.

This file is automatically generated by a robot program, so reader's discretion is required.