Throughout our lives, we can experience chest pain in different ways. Some people notice it from childhood or adolescence, while others feel it just before menopause. In the first case, doctors often say, “You’ll grow out of it,” and in the latter, “It will pass.” But ischemic heart disease (IHD) becomes a more pressing concern as we approach retirement age. What symptoms should raise alarm bells, and how can we tell an angina attack from a heart attack?
The Consequence of Strain
Sharp chest pain during physical exertion or emotional stress often stems from atherosclerosis and ischemic heart disease, which can cause angina. Irregular heart rhythms and disruptions in heart function result from reduced coronary blood flow and are linked to physical activity. A squeezing pain and a rapid heartbeat signal that the heart isn’t getting enough blood and oxygen.
A stable course without signs of deterioration over weeks characterizes the most common form of IHD—stable angina. This condition primarily affects men aged 50–60 (about 70% of patients) and women aged 65–75. With the right therapy, people can live and work without major limitations, but severe attacks require immediate medical attention, because they can lead to a heart attack.
Angina Attack
Pain in the heart area typically comes on after physical exertion or emotional stress. The pain isn’t sharp or cutting; it’s a squeezing sensation. The pressure behind the breastbone often radiates to the left shoulder blade, left arm, and left shoulder, gradually intensifying and sometimes getting worse with breathing. The pain can become unbearable. The person may turn pale and feel a fear of death. Generally, the discomfort lasts two to four minutes and usually doesn’t exceed fifteen minutes. Afterward the pain gradually eases (in stable angina it improves at rest), and the person often feels extreme fatigue and weakness.
During an angina attack, stop any physical activity immediately. Lie down on a high pillow or an elevated headrest, or sit in a chair with armrests. Help the patient breathe more easily: open a window, loosen their collar, and relax their belt.
First Aid
Chew and swallow a 250 mg aspirin tablet immediately, and place a validol tablet under the tongue; if validol isn’t available, take 30 drops of Valocordin or Corvalol. If you have angina, always carry nitroglycerin: during an attack, place one tablet under the tongue and repeat if the pain persists for more than five minutes. If the attack does not stop after nitroglycerin, this may indicate a myocardial infarction—call emergency services.
While waiting for the doctor, do not leave the patient alone, since they may faint. Allow the patient to smell a cotton ball soaked in ammonia and position them with their legs elevated to help revive them. If there is no heartbeat or breathing, begin cardiopulmonary resuscitation (CPR). If performed by one person, the rhythm is: four breaths, 15 chest compressions, and two breaths. If two people are assisting, alternate five chest compressions followed by one breath. Compress quickly: 60–80 times per minute. Perform artificial respiration using the mouth-to-mouth or mouth-to-nose method (through a handkerchief or gauze folded in half).
Actions During a Heart Attack
A likely symptom of a heart attack is very strong, squeezing pain behind the breastbone lasting from 20 minutes to several hours. Chest pain during a heart attack is usually more intense than during an angina attack and does not subside at rest. Pain that does not respond to nitroglycerin may radiate to the left side of the chest, the left arm, or the shoulder blade, and it can spread to the neck and jaw. Additional signs include agitation, sudden pallor, nausea or vomiting, cold sweat, a rapid and irregular pulse, shortness of breath, and a fear of imminent death.
Sudden weakness, low blood pressure, dizziness, heavy sweating, severe headache, acute coordination problems, or speech or vision disturbances are contraindications for taking nitroglycerin and validol. Do not give these first-aid medications without measuring the patient’s blood pressure.
Call an ambulance immediately and keep the patient calm with access to fresh air.
Place 30 drops of Valocordin or Corvalol on a piece of sugar and let it dissolve to help soothe the patient. To reduce the risk of blood clotting, give the patient an aspirin tablet—chew it and wash it down with water. Do not combine ibuprofen with aspirin. Give two tablets of analgin to help relieve pain. If blood pressure remains high, give a 0.5 mg nitroglycerin tablet under the tongue; after it fully dissolves, give the next tablet after five minutes. Repeat this no more than three times. If nitroglycerin is unavailable, give validol. In the event of clinical death, begin indirect heart massage until the resuscitation team arrives.
Life Goes On
For people with ischemic heart disease, angina, or after a myocardial infarction, continuously monitor heart rhythm. The optimal pulse rate is 55–60 beats per minute. If angina persists after a heart attack (a common occurrence), lifelong use of nitrosorbide, Isoket, or isosorbide-5-mononitrate may be necessary (consult an ophthalmologist about medications if you have glaucoma).
Monitor cholesterol every three months (the commonly accepted limit is 5.2 millimoles per liter). If cholesterol exceeds normal, cut out fatty and spicy foods, since those diets raise cholesterol. Choose plant-based fats over animal fats, and favor vegetables, fruits, whole grains, low-fat dairy, fish, and white (chicken) meat. Eat olive oil, fermented dairy products, and seafood three to four times a week; limit poultry, eggs, and sweets to once a week. Stop smoking and avoid alcohol if they were part of your life. Stress also raises cholesterol, so try to stay as calm as possible despite everything.
