Angina, the feeling of pain or tightness in the chest, is one of the most common heart problems in the UK. It is also one of the scariest, as it can be a prelude to a heart attack.
But a group of doctors are deliberately triggering the symptoms of angina in patients in their hospitals. “We are simulating an angina attack,” said Professor Rasha Al-Lamee, a cardiologist at Imperial College London.
This world-first study is for a good reason – to understand more about exactly what is causing the chest pain, and how it can best be treated.
Angina is usually caused when the arteries to the heart become narrowed by plaques. Most of the time, the heart can cope with this reduced blood supply – but during exertion, perhaps just from climbing stairs, the heart works harder and so needs more oxygen.
That narrowing means the heart can’t get enough blood – triggering the feelings of pain and gripping tightness in the chest called an angina attack.
The problem is often treated by doctors implanting into the narrowed artery a device called a stent, a wire mesh tube that holds the blood vessel open.
Stents have several uses, including in treating people who are in the middle of a heart attack or afterwards. But it is unclear exactly which people with angina should get one. Sometimes, people have the stent put it, but their symptoms continue, or wane temporarily, only to return.
That could be because something else was really causing their chest pain – for instance, a lung condition, stomach problem, blockages in smaller blood vessels, or even anxiety.
Surgery risks for no benefit
Those people are being unnecessarily exposed to the risks of the surgery, which include damaging the artery and rarely, triggering a heart attack.
The Imperial College team’s mission is to better understand which people will most benefit from a stent.
At the moment, doctors usually investigate with several tests, including ones that let them see the heart’s arteries on a scan, and measure the narrowing. But that’s not definitive, because many people have narrowed arteries as they get older, but they still cope with exercise without chest pain.
“The question is how narrow does that artery have to be to cause angina? No one has ever measured it,” said fellow cardiologist Dr Fiyyaz Ahmed-Jushuf.
The symptoms of angina
The main symptom of angina is sudden pain in your chest, neck, shoulders, jaw or arms.
According to the NHS, the pain may:
feel like tightness, squeezing or pressure, or like a dull ache. make you feel sick, breathless, dizzy or sweaty.These symptoms may be called an angina attack, episode or pain.
They are often brought on by exercise or stress– but sometimes there is no obvious trigger.
Angina attacks usually last less than 10 minutes. They should stop after resting for a few minutes or taking angina medicine.
This is why the Imperial College team are recreating angina attacks in the lab. Their unusual method involves getting the patient to take exercise, by pumping on bicycle pedals while lying on their back in the “cath lab”, the hospital room where stents are inserted.
While this is going on, a wire is inserted into the artery, which allows it to be imaged on a screen. At the end of the wire is a long thin balloon, which can be inflated, so that it partly blocks the artery – which means the amount of blood getting through the artery can be precisely controlled.
While the balloon is being slowly inflated, the patient tells the doctors when their chest pain begins. This means that the doctors find out the exact amount of narrowing that triggers the angina attack.
After this part, the doctors then implant a stent, as normal.
So far, the procedure has been done on 65 patients, and the results, reported last month in the journal, Circulation, have been eye-opening.
Eye-opening results
They revealed that on average, it takes more narrowing than was thought to trigger chest pain. And patients were more likely to have their angina cured by the stent if their pain was triggered by a large narrowing.
“What we found is that patients who had angina at the biggest [blood flow] drop, they were the ones that were most likely to get better,” said Professor Al-Lamee.
At the moment doctors may recommend a stent if there seems to be at least 20 per cent reduction in blood flow. The study suggests patients will only benefit if their angina attacks occur during exercise when there is 40 to 50 per cent reduction.
“The narrowing needs to be much more severe for you to get angina relief, so that explains to some extent why some people that we stent don’t get better,” said Professor Al-Lamee.
What did it feel like to take part in the study?
Trish Longdon, a fit and active 74-year-old, began experiencing a “horrible tightness” in her chest when she went jogging.
Doctors recommended investigations for a possible stent insertion, and she agreed to take part in the unusual Imperial College study.
Longdon said she was not apprehensive, as the team explained how it would better help understand her heart condition.
“I lay on my back in a bizarre position, but as I pedalled, it took probably about 10 minutes, for my heart rate to rise. Then there came a point where I said: ‘This is what I feel when I have to stop jogging.’
Fortunately, the stent was successful, and Longdon’s angina has not returned in the two years since the procedure.
The findings will not change how angina is treated overnight, as it was a small study and more research is needed to confirm the results, said Professor Colin Berry, a cardiologist at the University of Glasgow, who was not involved in the research.
But they have shed light on a crucial question for people with chest pain, of how best to help them, he said. Currently, one in three people who have a stent fitted are not cured.
Professor Berry said: “Patients think they’ve been treated successfully, the clinicians think they’ve done a great job. But the patient goes back into the community and the pain continues or goes away but then recurs. It’s a difficult experience.”
The more we can understand about why that happens, the better, he added.
Dr Ahmed-Jushuf said: “The ultimate goal is to ensure that the patients most likely to benefit from a stent receive one, while avoiding unnecessary procedures.”
Hence then, the article about why these doctors are giving people fake angina attacks was published today ( ) and is available on inews ( Middle East ) The editorial team at PressBee has edited and verified it, and it may have been modified, fully republished, or quoted. You can read and follow the updates of this news or article from its original source.
Read More Details
Finally We wish PressBee provided you with enough information of ( Why these doctors are giving people fake angina attacks )
Also on site :