Recovering from angina: what to expect - Online interview

thank you so in general terms if you have a diagnosis of angina lifestyle changes are very very important in terms of managing this condition the most important is any risk factors that you might have so if you're a smoker it's very important to stop smoking smoking is a huge risk factor for developing coronary artery disease or narrowing in the arteries of the heart in the first place but if you do have angina and you've already got established arrows in the arteries of the heart then smoking actually increases the risk of heart attacks beyond the risk of developing the disease in the first place it's very very important to stop smoking completely even smoking one cigarette can increase the thickness of cells which can increase the risk of heart attacks so that's a very important one a second one which unfortunately applies to a lot of us after lockdown is the need to reduce weight so if someone is overweight then tackling that is a huge problem it can be but it is something that needs to be done in conjunction with dietitians and exercise programs um but losing weight will reduce blood pressure which itself is a risk factor for further coronary artery disease type events um it will also actually help with exercise capacity so if one's carrying less weight then one's able to do a lot more and your exercise tolerance before you develop chest pain around your own it becomes less but in general in long in the long term it's very important for people to have an ideal body weight um coinciding with that is also dietary advice um so to make sure in general terms that people have um lots of fresh fruits and vegetables a low-fat diet lean meat avoid red meat limit that if you can and also to avoid saturated fats and sugar sugar is the big evil really because it's so um plentiful and such a little amount um can cause a very big increase in weight and that's probably the biggest problem that we face so limiting one sugar content and if carbohydrates are being eaten in excess again that's another risk factor both the sugar and the carbohydrates particularly in the west lead to condition in some people called central obesity where any excess energy is converted to fat and that fat is dumped in around the intestines and that unfortunately increases the risk of diabetes heart attacks and just the development of coronary artery disease so that's important in conjunction with all of this physical activity is very important and actually when we talk about physical activity immediately people think that means going to the gym at six o'clock in the morning and pounding away for three or four hours well that's generally not the case actually the advice is is much more moderate much more modest and really if people just walk for half an hour every day briskly that is a very very good amount of exercise and that's essentially what we're designed to do so physical activity now of course the problem with angina is often angina where you've got narrows in the artery of the heart is provoked by exercise so there may be there will be people who have angina initially whose symptoms aren't under control and therefore they will be getting angina before they can do very much of course they've got to limit their exemption um to the point that they're getting angina but hopefully with medication if their symptoms improve they'll be able to do more but again depending on where they are who they're being treated by they should hopefully be cardiac rehabilitation classes available to help them guide them through that increasing physical activity process in a safe way um the final thing which has always been in the literature and has always been difficult to define is that nebulous thing called stress patients who have angina are very familiar with the fact that stress will provoke angina but we also feel that our stress probably in the long term um is a risk factor for worsening of coronary artery disease and probably development of coronary artery disease in the first place um so limiting stress just from symptoms alone is probably a good thing for them to do as well as trying to reduce their risk going forward that's a really good question so does angina require treatment yes it does always require treatment um in the vast majority of people with angina who've got what we call stable angina so that's predictable chest pain coming on with exertion we usually manage that in the outpatient setting and the vast majority of them will be managed with lifestyle changes that we've already discussed but with medication um the most important thing to bear in mind actually is in the modern world with the strategies that we have available for the vast majority of people with angina will have a very very good outlook on medical therapy can it be cured as things stand current science and unfortunately not but we can definitely reduce this likelihood of causing harm and also um we have treatments available that can make people's quality of life excellent so there's no reason that once you've got angina you can't have an excellent quality of life with a very very good outlook but as things stand you can't cure it now so that's a really good question um with angina with any uh condition that we have in medicine there are two types of medicines that we give um they're not always mutually exclusive but they're those treatments that we give that help improve survival um so in the case of angina reduce the risk of death heart attacks and those are what we call prognostic medications and the prognostic medications that we have are aspirin which reduces the likelihood of clots forming in arteries and heart attacks and statins and statins work by reducing cholesterol a particularly bad cholesterol called ldl which will prevent further fat deposits developing in the arteries and also actually the other thing they do is the statins will make the plaques the fat deposits that we have more stable and less likely to rupture which is the thing that occurs when heart attacks happen so aspirin and statins are the two major classes of drugs that we give to try and improve people's survival there are others such as ace inhibitors which have been used for blood pressure control which do confer some prognostic benefit or survival benefit but in in the great scheme of things the amount that they confer is very much less than the aspirin the status the majority of the drugs that people will be on for angina will be to try and improve their quality of life with angina the symptoms are mainly chest pain or chest tightness and exertion or breathlessness and the sort of drugs that we use will be things like beta blockers and beta blockers work by blocking the action of a hormone called adrenaline sometimes in the literature particularly the americans call that epinephrine and what that will do is to help slow down the heart and reduce the force of contraction of the heart and both of these things reduce the energy requirement of the heart which lessens the likelihood of developing angina so that's how beta blockers work another class of drugs which is very commonly used as nitrates and so the nitrates usually in a sublingual spray form is something that most people will be familiar with they help relax smooth muscle which is muscle which are like rings around the arteries the coronary arteries and the blood arteries the blood supply arteries of the heart they help dilate or relax those arteries to increase blood flow into the heart muscle they're also prescribed in a tablet form usually in a once a day medication work by the same method another class of drugs is the calcium channel blockers again they relax those arteries improve blood flow down those heart arteries and reduce the likelihood of developing chest pain with exertion there are others which are new but the but these are the major ones that most people will be familiar with thank you so that's an interesting question so i think the first thing we need to just do is to define what kind of surgery is available for angina treatment now there are two major types of surgery one is the traditional one that most people think of and that is where a big scar is made on the chest the sternum is opened and grafts taken from the leg or from the arm or from the chest are put onto the narrowed arteries to bypass those narrows so that's bypass surgery that's the traditional one but minimally invasive procedures are also available and the most common that most people will have heard of is angioplasty and that's something that's performed by cardiologists by taking a tube up from one of the arteries in the wrist or the top of the leg and then a balloon is threaded across the narrowing and the stent is put in to open up that vessel keep it open with surgical procedures either bypass surgery or angioplasty the most common thing that most patients say to me when they come to see me is that they feel that i must confer some kind of survival benefit prognostic benefit now for stable angina which is what we see in the outpatient setting actually that's not true the vast majority of patients are best managed with medical therapy and the surgical type procedures either bypass surgery or angioplasty is typically reserved patients who have ongoing symptoms despite being on optimal therapy so that's being on all those sorts of drugs that we talked about earlier if they're still getting symptoms their quality of life isn't very good then either opening up their arteries with stents or bypass surgery is something we've considered and the choice between the two will be dependent upon the type of coronary artery disease they have how expensive it is what it involves how much calcium there is whether they've got diabetes and so on and the risks for one procedure in the other in terms of survival benefit for stable angina there is a small subset of patients with angina who may have very extensive problems with blood flow into their heart muscle in whom bypass surgery in particular might be your benefit the role of angioplasty in angina really is um primarily reserved for people who come in with unstable anger so that's people coming into hospital with pain at rest or with a minor heart attack or a big heart attack and in those groups of patients undoubtedly there is evidence that angioplasty extents improve survival but in the outpatient setting angioplasty is reserved for patients who carry getting symptoms despite being on optimal therapy so that's a really really important question because it's to do with the heart and actually we're very very fortunate to be living in the world that we do so the take-home message is in the modern world if you've got angina there is no reason that you should not have an excellent quality of life for the treatments that we have available and a very good long life with the treatments that we have available and that's what the vast majority of patients should expect

Channel: Top Doctors UK

Views: 1,610

Keywords: heart disease, angina, angina symptoms, angina diagnosis, managing angina, living with angina, angina treatment, surgery for angina, dr khalid barakat, top doctors, angina windsor, angina maidenhead, chest pain, bmi the princess margaret hospital, the bridge clinic maidenhead, cardiology, cardiology windsor, cardiology maidenhead

Id: 10otRRI9_Lk

Length: 11min 48sec (708 seconds)

Published: Sun Apr 24 2022