PATTERNS ANGINA: JANE
Three women make up my last three examples of angina. The first, Jane, is sixty years old. She has been well all her life, and sailed through menopause with no difficulty. In fact, she prided herself on having done so without the need for hormone replacement therapy. However, now that her children were grown up and moved away, and she and her now-retired husband had bought a smaller house near the sea, her life had become much less active. She took the occasional walk, but the garden took only a few minutes a day, and she was becoming a couch potato. A nonsmoker and nondrinker, she ate well, and was steadily putting on weight.
Jane’s extra weight was the main reason for her visit to the doctor. She was becoming breathless and a little tight-chested when walking up the steps to her front door, or walking over the dunes to and from the beach. She was less able than before to keep up with her husband, and this irked her. So Jane asked her doctor for a diet plan so that she could lose weight.
The tight-chested feeling worried her doctor, who ordered an EKG and various blood tests. Jane’s blood pressure was normal, but her blood cholesterol level was over 350mg/dl—well above the average—and her EKG showed changes suspicious of ischemia, the medical term for a lack of blood supply. A treadmill test confirmed that the tightness in the chest was linked to further EKG changes that showed that one of the coronary arteries was not delivering enough oxygen to the left side of the heart.
Jane was surprised to find that this tightness was, in fact, angina. The subsequent angiogram showed that she had one narrowed area in the main left coronary artery, and that the area beyond it was now being served by new collateral arteries that had grown in from another coronary artery. In fact, her heart was trying to deal with the problem in its own way—by producing a natural bypass.
The surgeon and cardiologist agreed that with medical treatment to keep the coronaries as open as possible, and a program of judicious exercise and weight reduction, Jane might well get away without having surgery.
She is now eating and exercising better, has lost over 28 pounds, no longer .experiences her attacks of tightness, and is feeling much better. Her cholesterol level is down to 270mg/ dl—still relatively high, but not dangerous for a woman of her age. Jane has to visit her doctor every month or so, but there is every chance she will be able to avoid surgery.
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