Angina – From Diagnosis to Treatment Part 1 – Diagnosis

Part 1 of a 3-Part Series

Introduction

Earlier this year, I was diagnosed with Angina pectoris, pain in the chest caused by restricted blood flow to the heart during periods of exertion. The following is a three-part essay of my journey from first experiencing angina, through testing and diagnosis, and finally, what I consider a really clever (and medically accepted) treatment plan.

The purpose of this blog is to relate my personal experience in a way that others may learn from it, especially if they experience the same symptoms, or know someone who has. There is much technical information associated with the diagnostic tests, and I have provided links to Internet sources for those of you who want more on the technical details. They are not essential for understanding the basic story.

Part 1 – Diagnosis Angina

Over the past year—mid-2016-early 2017—I have had very occasional low-grade pain in my chest. It did not last long, and typically, I dismissed it as either indigestion or esophagitis. Yes, I did notice some additional discomfort radiating across my left shoulder and down my left arm. That was the clue that I overlooked. Until this past February, I would have classified the “pain” as simply an annoying discomfort of no real consequence.

Then, this February, my friend and I traveled to New Orleans to visit the World War II museum. We spent two 8-hour days on our feet looking at all of the exhibits. I had no pain or discomfort of any kind. The evening of the second day, however, as we were walking—briskly—to dinner it began. We had to travel two long blocks. At the end of each block we had to wait for traffic lights to change to cross the street. By the end of the first block, I experienced more than “annoying” pain in my chest, directly under my sternum, and also had the dull aching pain in my left arm. While we waited for the light to change, the pain subsided and went away. This was repeated during the second long block. From that point, we turned and followed a series of much shorter blocks. I also elected to walk at a slower pace. The discomfort did not occur again, and on the walk back I suggested a slower pace, you know, to just be able to take in the sights of New Orleans. Otherwise, I said nothing.

Routine Doctor’s Visit

Several weeks after returning home, I had a routine physical appointment with my doctor, Dr. S. Prior to seeing the doctor, a nurse always takes my blood pressure and asks a few routine questions, including asking about how I have been feeling. That prompted me to describe the above events. She made a couple of notes, left the room briefly, then returned with a portable EKG and took a quick scan of my heart.

Several minutes later, Dr. S. came in. She asked about the chest pain and I repeated the events as she studied the EKG. She said she saw a slight difference from my previous EKGs and she also said that I described the classic symptoms of angina. She had her office make an appointment for me with a cardiologist.

The shaded areas show where angina pain may be felt.

At this point, you need to know something about me. For the most part, I have viewed life as an adventure, and while it has not always been pleasant, everything was an experience and a learning opportunity. Thus, it was with as much curiosity as concern that began my “journey through angina” that would last the next ten weeks (and hopefully, many more years).

The Not-So-Routine (for me) Cardiologist Visit

The Cardiologist, “Dr. B.,” is a tall, academic looking gentleman, clearly focused on the task at hand. I should note that his office appears to be “paper free” of records. He had my medical records from Dr. S on his laptop in the examination room. He asked me to describe what happened, and I repeated the New Orleans events to him. I closed by mentioning that Dr. S suggested I had angina. “Oh, you definitely have angina,” he said matter-of-factly. We talked very briefly, and he concluded, “I want you to have a stress test. We do that here. They will set up an appointment for you next week, or maybe the following week.”

At this point—and since, no medical person ever hinted at any sense of urgency. My interpretation of this was that I was not in any immediate danger of a heart attack, and I sort of let the schedule of events flow at relaxed pace.

In Part 2 – Testing to determine the type of angina and determine a manner of treatment.

Angina – From Diagnosis to Treatment Part 2 – Testing

Angina – From Diagnosis to Treatment Part 3 – Treatment