Unusual Angina?

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Submitted by Dr T on May 16, 2012 – 12:00pm

Question: 
I have been diagnosed with coronary artery disease, based on an exercise stress test, EKG’s, Echocardiogram and my description of chest tightness after walking several blocks. I currently take the “big four” heart medications: beta-blocker, nitrate, statin, aspirin. My chest tightness only seems to occur when I walk several blocks (medications are improving my symptom-free distance). My apartment has a 14-step staircase, which, as a test, I climbed up and down 10 times without stopping. There were absolutely no angina symptoms from this. My doctor agrees that the stair climbing is more stressful than just walking on level ground. I do get out of breath, but no more than anyone who climbed 10 flights of stairs, I suppose.  Why doesn’t this cause my angina to occur? I should note that I make these climbs in the morning before taking any meds. This sounds strange to me. My doctor says if I walk up 10 flights with no symptoms he’s not too worried about me. What do you think?

Hi Ken,
Angina occurs sometimes very predictably and sometimes not. It sounds like you are under good control at the time, but since you have known CAD, you need to have regular follow-up with your doctors, and especially focus on a heart-healthy life style:

Medical therapy alone (a combination of meds, heart-healthy activites etc.) has proven to be at least as effective as interventions such as stenting in patients with chronic stable angina.

Hope this helps,
Dr T

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