What if medication fails to control angina?
Doctors may recommend surgery or angioplasty if drugs fail to ease angina or if the risk of heart attack is high. Coronary artery bypass surgery is an operation in which a blood vessel is grafted onto the blocked artery to bypass the blocked or diseased section so that blood can get to the heart muscle. An artery from inside the chest (an "internal mammary" graft) or long vein from the leg (a "saphenous vein" graft) may be used.
Balloon angioplasty involves inserting a catheter with a tiny balloon at the end into a forearm or groin artery. The balloon is inflated briefly to open the vessel in places where the artery is narrowed. Other catheter techniques are also being developed for opening narrowed coronary arteries, including laser and mechanical devices applied by means of catheters.
Can a person with angina exercise?
Yes. It is important to work with the doctor to develop an exercise plan. Exercise may increase the level of pain-free activity, relieve stress, improve the heart's blood supply, and help control weight. A person with angina should start an exercise program only with the doctor's advice. Many doctors tell angina patients to gradually build up their fitness level--for example, start with a 5-minute walk and increase over weeks or months to 30 minutes or 1 hour. The idea is to gradually increase stamina by working at a steady pace, but avoiding sudden bursts of effort.
What is the difference between "stable" and "unstable" angina?
It is important to distinguish between the typical stable pattern of angina and "unstable" angina.
Angina pectoris often recurs in a regular or characteristic pattern. Commonly a person recognizes that he or she is having angina only after several episodes have occurred, and a pattern has evolved. The level of activity or stress that provokes the angina is somewhat predictable, and the pattern changes only slowly. This is "stable" angina, the most common variety.
Instead of appearing gradually, angina may first appear as a very severe episode or as frequently recurring bouts of angina. Or, an established stable pattern of angina may change sharply; it may by provoked by far less exercise than in the past, or it may appear at rest. Angina in these forms is referred to as "unstable angina" and needs prompt medical attention.
The term "unstable angina" is also used when symptoms suggest a heart attack but hospital tests do not support that diagnosis. For example, a patient may have typical but prolonged chest pain and poor response to rest and medication, but there is no evidence of heart muscle damage either on the electrocardiogram or in blood enzyme tests.
Are there other types of angina?
There are two other forms of angina pectoris. One, long recognized but quite rare, is called Prinzmetal's or variant angina. This type is caused by vasospasm, a spasm that narrows the coronary artery and lessens the flow of blood to the heart. The other is a recently discovered type of angina called microvascular angina. Patients with this condition experience chest pain but have no apparent coronary artery blockages. Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs. Microvascular angina can be treated with some of the same medications used for angina pectoris.
What I need to know about Hepatitis A
What is hepatitis A?
Hepatitis A is a liver disease. Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right.
You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it. What causes hepatitis A?