Although coronary heart disease is widespread throughout the world, fear and misconceptions about it probably cause more disability than the disease itself. Here are some of the statements one frequently hears made about the subject:
“A coronary always means the end to further useful life”
This belief is widespread and wrong. Most coronary occlusions only involve a small branch of the coronary tree and the blocked vessel may be bypassed by the “collateral” channels which lie unused in the tissues awaiting this eventuality.
These can be so efficient that, after recovery, the patient may have no disability at all or else only on extreme exertion.
“The patient with coronary disease must rest all the time”
Certainly in the acute phase of an attack the process of healing the damaged heart muscle is assisted if the body is rested. The need for rest and its degree and duration varies with each case; only your doctor can decide this.
But once healing is complete, further rest rarely achieves anything of value and is only likely to increase disability by adding the effects of physical unfitness and lack of self-confidence.
In some patients, however, it is difficult for the heart to supply an adequate quantity of blood to the tissues. This condition is called HEART FAILURE. It is a very special situation and often only temporary.
It may be caused by a number of conditions besides coronary disease. When it is present, and only your doctor can tell this, a period of rest may be necessary.
Later, depending on the degree of recovery, increasing activity will usually be possible.
“Exertion is harmful after a coronary attack”
This is a variation on the theme already discussed about the need to rest; it is usually just as wrong. The heart has enormous reserves of power which are often never used in ordinary living.
It is this reserve which enables men to “move mountains” or to run a mile in less than four minutes. After many coronary attacks the reserve power of the heart is hardly decreased at all and is available for use.
In general, a patient with coronary disease who is exerting himself too much will develop symptoms; this is nature’s way of warning him to ease down. The symptoms involve a special type of chest pain and breathlessness.
One difficulty, however, is that rather similar symptoms can be produced by physical unfitness and by anxiety, and the failure to distinguish between them leads many patients to restrict their activities too much.
If you are in doubt about this, it is best to talk it over with your doctor.
“One coronary leads to another”
Accompanying this notion is the idea that with each further attack the chances of survival are slim. Some people even believe that it is impossible to survive more than three coronaries.
Actually, although further attacks may occur, it is very common for patients to go 10 or 15 years without a recurrence, and some patients NEVER have a recurrence. Moreover, there is NO LIMIT to the number of coronary attacks a patient may have and survive.
“Nothing can be done to help the sufferer from angina pectoris”
In fact, doctors have had a medicine called Trinitrin (Nitroglycerin) available for many years which is of tremendous help in angina. This substance is harmless to the body as a whole, but if a tablet is chewed or sucked it nearly always relieves the pain quickly.
Moreover, many times a patient can prevent an attack by taking a tablet before embarking on effort likely to cause pain. If the tablets are swallowed they are much less effective.
Although Trinitrin relieves anginal pain so quickly, many patients come to fear that, as with other pain-relieving remedies, its effectiveness will decrease with repeated use, or else that they will become addicted or dependent on it.
This is another mistaken idea.
Trinitrin is not habit-forming and docs not lose its effectiveness with repeated use. Many patients have taken 20 – 30 tablets daily for years with no ill effects.
Moreover, as this wonderful remedy has been proven for more than 100 years (and never improved on) there is no likelihood of unsuspected ill effects being discovered now.
“Work is impossible after a coronary”
In fact, most men go back to their old jobs after a coronary attack, and experience has shown that they suffer few or no ill effects.
They also have excellent work records and very often less absences from work due to illness than their apparently healthy workmates. In about 20 percent of cases, return to work presents some special problems.
Perhaps the old job is now too strenuous and cannot be satisfactorily modified (many jobs of course can be), perhaps industrial regulations forbid the employment of heart sufferers; for example, this might apply to tram and train drivers or pilots of commercial aircraft.
Quite often the barrier to the patient’s return to work is a problem involving Workers’ Compensation; sometimes it is a fear in the mind of the patient, his foreman, or his employer that his previous work even if modified could cause another attack.
If the patient is found fit enough to work, every effort is made to find work of a suitable nature.
“Coronary disease runs in families”
This is certainly true and if one or both parents have coronary disease their offspring are more likely to develop the disease, too.
But the increased risk is not very great, and no matter how prevalent the disease in your family tree, this does NOT mean that you will inevitably suffer from it; you may not inherit the trait at all.
An intelligent person, knowing that the tendency to coronary disease is present in his family, should simply make an increased effort to live by the simple hygienic principles already outlined.
“Coronaries always occur out of the blue”
It is true that a coronary attack may occur in a patient who feels perfectly fit and even in patients who have been found fit after a medical examination.
But usually there are some warning symptoms which it is best for us to know about. We must always remember, however, that it is a great mistake to try to diagnose illnesses in ourselves (or others) on the basis of information gathered from reading and other sources.
It is the doctor’s role to make a diagnosis; he is trained by years of study and experience to do so. You are doing your part to maintain your health when you notice unusual and persistent symptoms and report them to your doctor.
Shortness of breath produced by effort customarily performed without breathlessness should be looked into.
Heart trouble is only one of a number of possible causes. Breathlessness produced by some activity to which the body is not accustomed is more often due to physical unfitness than any other cause.
Shortness of breath which wakes you from sleep can be an important clue to heart trouble, but it can be due to nervousness or to asthma.
The most important symptom of coronary disease is pain in the chest; on the other hand, there are so many causes of pain in the chest that very few adults go through life without experiencing it at some time.
Most of these causes are simple and trivial. However, if you get pain in the chest see your doctor and let him decide its cause.
Above all, don’t keep it to yourself and worry over it, for in most instances medical advice will lead to complete reassurance and relieve your mind.
Undue fatigue is sometimes due to heart disease, but more often it is due to prolonged worry about personal, domestic, or business problems. Sometimes an inadequate diet, chronic infection, anemia, excessive smoking, or alcohol is responsible. If you feel unduly tired and don’t recuperate normally after a rest or holiday see your doctor for further advice.
Besides these symptoms, which if cardiac in origin, would alert the doctor to the possibility of coronary disease, there are other important pointers to an increased risk, especially obesity, high blood pressure, and diabetes.
As these conditions are often only found by a ROUTINE MEDICAL EXAMINATION, such examinations are clearly important after middle life, for they can help to protect you from coronary and other diseases.
“All patients with coronary disease die suddenly”
Many people think this is true, but they prefer to skate around this question as too frightening to think about, let alone discuss.
Some patients do die suddenly and unexpectedly from coronary disease, and as this is often featured in newspapers when prominent people are involved it is inevitable that many believe it to be a common and frightening prospect.
Certainly far too many sufferers from the disease believe that sudden death is to be expected. The truth is that most patients with coronary disease DO NOT die suddenly.
The problem is rather like the risk of sudden death in a motor-car accident – if you drive a car you run more risk of being involved in a car accident than a non-driver, and as more and more cars appear on the road this risk increases.
But despite the appalling number of fatal road smashes the number who die is still only a tiny fraction of the total of motor-car drivers.
Thus, no normally adjusted driver feels a dread of a fatal smash every time he drives off in his car, but most intelligent drivers do drive carefully in order to reduce the small risk they run to an even smaller one.