How it all started
It was late June 2010 and my son along with his wife and two little sons were coming to spend the summer holidays with us. My wife Sandra and I were excited and spent the entire week making the house ready for their arrival; we were making their rooms ready, cleaning the swimming pool and making up the lawn etc. We always waited for this time of the year when the family is together and the company of my two grandsons made me and my wife very happy.
I am 61 years old and healthy but about 20 kgs overweight. I have smoked for almost 40 years. The week was very tiring for me as very frequently I had mild chest pain, heartburns and also a feeling of indigestion. I would take some antacid tablets and the pain and uneasiness would go away. Sometimes the pain and uneasiness lasted off and on for about six to seven hours which most of the time went away with antacids. I never gave importance to it as the week was full of excitement for the arrival. I had planned to visit the family doctor next week for this.
I have a good business of Estate agents and most of the time I am with my wife who is also my secretary. Most of the time I spend out of my working time, is in my office, as site visits are made by other company executives. It was the night before the arrival of my son and his family I remember the date 27th of June 2010. We arrived home late after shopping. We had eaten out and I planned to have a glass of wine before going to sleep. This always made me sleep better.
That night after sex to my great surprise I found myself out of breath to the point I could not catch it back for a minute or two and I thought I was maybe seriously out of shape or I may be getting too old or was it that I over ate ?? ?? Well... I was confused with myself.
It was almost two weeks now and me and my wife were fully occupied with our son and his family. To my surprise my feeling of heartburns and indigestion were not there anymore or rather I had started to forget about it. We were on the beach very often and every time I walked on the sand I would have to pause to catch up with my breath. I am getting old I told myself and got occupied with my grandsons.
It was August and I was sitting at my desk working in the office and had the same kind of "attack." The same symptoms occurred again and lasted for some time. This time the pain was severe in the middle of my chest. This "attack" also felt a little like indigestion so once again I took antacids and this time they did not help very much but yes the pain subsided a bit, my eyes also started feeling funny, I could not focus on what was happening, I was fainting, I just felt I was being taken on a stretcher.
I was taken to the emergency room where they did an EKG, which came back to be normal. I spent the night in the hospital and had a stress test scheduled for the next morning. The stress test came out "abnormal," and I was told that I needed to have a heart angiography to check for blockages in my arteries.
I was scheduled for a heart Angiography the next morning. The heart angiography came back just about normal and no blockages were found except for one which was 50% blocked, this was much below my cardiologist's standard. The doctors diagnosed me with angina. I was told to follow up with my family doctor and to follow up with the heart doctor in one month. At this point almost equal to $25,000 later we didn't know what this Angina is from. I was put on Coreg Cr, an 81mg aspirin a day and Isosorbide MN ER that made me dizzy, nauseous and gave me a horrific headache.
What causes angina?
Angina is the pain you feel when one or more of your coronary arteries becomes damaged, blocked or narrowed and isn't able to bring enough oxygen-rich blood to your heart. The pain may occur during physical activity, exercise, stress, periods of extremely cold or hot temperatures, after heavy meals or while drinking alcohol or smoking.
I was following up with our family doctor. His point of view was “Usually angina only lasts a few minutes, but if the pain lasts longer, it may mean that you have a sudden, total blockage of a coronary artery or that you may be having a heart attack and you need to get help immediately. If you are experiencing chest pain or pressure that is not relieved with rest or nitro-glycerine after 15 minutes, you may be having a heart attack. Don't delay calling emergency immediately."
I was stressed as my pain lasted for five to seven hours. My cardiologist believed I had GERD {Gastro-esophageal reflux disease} which is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food) because my cholesterol levels are always low, so he referred me for an endoscopy. That was negative but that doctor thought I might have oesophagal spasms. That didn't seem right since nitro-glycerine helped so I was finally lucky to be able to get in to see another cardiologist, who doesn't take new patients and got a final diagnosis from him. I have the rarer variant angina which of course I did not believe. Now I wanted to know how many types of Angina are there.
What are the types of angina?
Stable angina
is pain that is triggered mostly due to physical activity or emotional stress. The duration and location of pain are mostly the same in various episodes of angina. Hence Stable Angina is usually predictable. The chest pain or discomfort is mostly relieved by resting or with medication. If you have stable angina, try to note down its pattern, how long it lasts and which activities trigger it and how the pain is eased. This will help you provide better information to your doctor and also rule out the chance if you are developing unstable angina.
Unstable angina
is a typical chest pain which is unexpected and is triggered even when the patient is at rest and not doing any physical activity. It is typically a chest pain that is new and unexpected and happens when you are at rest or without stimulating activity. If you have chest pain that is new, worsening or constant, you are at greater risk of having a heart attack, an irregular heartbeat (arrhythmia), and even sudden death. See your doctor as soon as possible.
Variant Angina
also known as Prinzmetal's angina has symptoms similar to unstable angina. It occurs at rest rather than on execration or any physical activity. But the fact that makes it different from unstable angina is that the patients having Prinzmetal angina show a negative stress test. The pain episodes do not follow any physical activity or emotional stress and are typically experienced between midnight and early morning. It is mostly caused due to spasms of an epicardial coronary artery
Micro-vascular angina
is somewhat similar to stable angina which is experienced when in some physical activity. It is mild chest pain and shortness of breath, but the angiography reports are negative with so significant artery blockages or CAD. It occurs because of improper functioning of tiny and microscopic blood vessels that are spread all over your heart and provide oxygen to your heart. (This condition may also be referred to as Cardiac Syndrome X, not to be confused with metabolic syndrome, which is also known as Syndrome X.) Since microvascular angina is not characterised by any significant arterial blockages, it is difficult to diagnose. Although this problem is quite common.
I was back to square one. I did not know what to do. How to get a confirmed diagnosis? So I went back to my first cardiologist. After a lot of consultation and phone conversations with the endoscopist, my doctor confirmed that I have episodes of oesophageal spasms which last for a few hours and I am also having microvascular angina.
I was immediately put on a course of 300mg of Ranitidine once a day and Atorvastatin 20mg along with aspirin 100mg. once a day. For about 3 months I had no pain or uneasiness but whenever I had sex or walked on sand or tried to climb stairs I had shortness of breath that took time to get back. I was very uncomfortable with this.
On every of my visit to the cardiologist I would ask how long will I have to go on with the medications and when will I be able to get more active. My doctor always said "you will have to go on with these medications for the rest of your life of course we can discontinue the Ranitidine. But you cannot stress yourself physically.'" I was drifting away from active life. This was now my biggest stress...
A year passed by and it was time for the summer vacations and my son and his family were coming over. My wife was the busiest, she had to do most of the work as I was asked not to stress myself. This was not only depressing but also made me feel handicapped.
The first evening at the dinner table when the entire family was there I was the topic of discussion. Why don't you try IECP? - My son suggested! - IECP? What is IECP? - I asked.. Well - he said.. - IECP means Increased External counterpulsation. It can help you with most types of Anginas.
Immediately after dinner, the only thing on my mind was to be on the internet and find out what is this IECP and how it works for Angina?
Increased External Counter Pulsation (IECP) is performed as a non-invasive treatment to lower the number and intensity of angina episodes. Treatment is administered through three pairs of external inflatable cuffs that are applied around the lower legs and upper legs. These cuffs continuously inflate and deflate between the resting period of the heartbeat and increase blood returned to the heart.
The basic principle of ECP treatment involves increasing the amount of blood returning to the heart, which helps supply, more oxygen to its starved areas. With more oxygen available, the heart can function much more efficiently and therefore, reduce chest pain. The treatment schedule includes 7 weeks of continuous treatments which require daily visits for 1 hour, with Sunday being a holiday.
Normal heart function depends on maintaining a balance between oxygen supply and demand. Oxygen consumption by the cardiac muscle is determined by how fast your heart is beating and how well it pumps. The amount of oxygen available is determined by blood flow. Approximately 80 per cent of the blood flow to the cardiac muscle tissue occurs when the heart is resting. Clinical studies indicate that ECP treatment may create a "natural" bypass around the blocked arteries. ECP treatment encourages blood vessels to open or form small channels that become extra branches. These channels, or collaterals, may eventually become permanent pathways to the heart muscle that was previously deprived of blood flow and adequate oxygen.
I had decided to undertake a course in IECP and I wanted to find out if I am the candidate for it.
Luckily for me I found a centre performing IECP just about 50 km away from me. On scheduling an appointment for the next day at 10 am, I was excited for the first time in a year. I could not sleep that night waiting for the morning. I and my wife were there exactly at 10 am. In the first stage all my medical history was taken and a stress test prior to beginning IECP treatment. This will establish the exercise capacity and provide final clearance to begin treatment. More importantly, it will identify the severity, frequency and duration of chest pain with exercise that you may have. - said the doctor. After completing 30 treatment sessions, there will be another stress test measuring the same values. The two stress tests will be compared which will indicate any changes in chest pain and exercise capacity. This was a comparison between the pre and post-treatment benefits.
I was given a feeling of treatment; a chance to experience exactly what treatments will be like, a full explanation of the treatment sessions, education about the treatment process, and a 15-minute trial of the IECP machine in operation. The first official treatment session began the following day at 2 pm.
I underwent my first treatment session. My legs were encapsulated in BP-like large cuffs and EKG leads were placed on the chest. An SPO2 sensor was fitted on my finger. It took one hour for the treatment to complete. I felt no discomfort rather I slept during half the session. After about 15 treatment sessions I found I could easily walk longer on the sand and also climb the stairs easily. I stopped smoking for eight months now.
It is six months now since I completed the 35 hours sessions. My stress test had shown a marked improvement. My doctor at the IECP centre suggests me take another course of ECP of 35 hours as he says more collaterals will be formed and Micro-vascular angina will be treated for the rest of my life. I am excited and full of energy. I do not have to catch my breath on physical activity as before. I feel normal. But I fail to understand just one thing - "Why did my cardiologist not tell me about this therapy for one year?”
TMC adds:
Talk to your doctor you could also be a candidate for IECP.. Choose an IECP center near you. It's a better technology and better equipment. Tell others about IECP. There are a number of happy people who have had an IECP therapy and are happy and leading a normal life