There is some tendency for arterial narrowing, involving especially the coronary arteries and the cerebral arteries (which feed blood to the brain and whose narrowing causes strokes), to run in families. There is obviously not a great deal that can be done about this. If you have it in the family you may be stuck with it! A family trait however is not especially strong so there is no need for undue worry, but it does mean that attention to other risk factors is even more important. On the other hand, if the family trend is very bad, for example several members of the family having or dying from heart attacks at a young age, and especially if it involves several generations and women in the family (in which it is unusual before the menopause) it may be due to a profound abnormality of blood cholesterol or related body fats, which can be diagnosed easily in a blood sample taken after fasting. Such people may have a very high blood level of cholesterol or the related substance triglyceride, and it is now known that treatment with a diet, drugs, or both, can have a favorable effect on the risk of coronary attacks. It should be emphasized however that this type of abnormality is very rare.
When the blood flow through the coronary arteries is sufficiently restricted to cause angina, there are two basic ways of helping: either the needs of the heart can be reduced so that and inadequate blood supply becomes adequate, or the arteries themselves can be treated to increase the blood supply. The former method is achieved with medicines and the latter, usually, with surgery.
The medicines work by lowering the hearts needs. They do this by slowing the heart rate, reducing the blood pressure (hence the “resistance” into which the heart has to pump) and also the force with which the heart contracts. There are three groups of drugs which are effective in this way; they are called beta-blockers, nitrates and calcium antagonists. To a minor extent they may dilate narrowed coronary arteries where “spasm” has narrowed them over and above the thickening in the walls.
Unfortunately, there is no simple test which can be used to detect coronary disease in the way that the chest X-Ray can be used to detect lung cancer. To be effective, such a test would have to be simple, quick cheap, safe and very reliable.
A lot of effort is going into ways of devising a suitable method, but at the moment the only methods we have are the electrocardiogram, the exercise test, isotope techniques and arteriogram. The electrocardiogram measures the heart’s electricity but although it invariably becomes abnormal after a heart attack, it is often normal in patients who have angina, let alone those with no angina whose arteries may be narrowed. An improvement is stressed by physical activity, when some of the heart’s reserve is being used. This test it still a poor indicator of those with incipient trouble, however, and can even be misleading because in those with no symptoms the test is falsely positive more often than truly positive; in other words, it may suggest an abnormality where none exists, more often than suggesting an abnormality where there actually is one. This is because the flow of blood through the arteries may not be significantly reduced until the artery is narrowed to about 60 or 70% of its cross-sectional area, and because abnormal electrocardiograms can be caused by other types of abnormality.
The most important by far is smoking. Although most people are aware of the risks of lung disease, especially chronic bronchitis and lung cancer, many are not so aware of the enormously higher chances of developing “coronary heart disease”. Smoking 20 cigarettes per day makes one 100% more likely to develop this serous heart disease. Knowing this it remains true that we, as individuals, can do more to help ourselves and protect our future than can the medical profession, while we remain ignorant of the essential underlying cause.
If it was a similar tight central pain but of short duration it might have been due to a temporary reduction in blood supply thought one of the coronary arteries rather than a complete and permanent blockage. The heart muscle is then not damaged permanently and no “heart attack” occurs. The temporary inadequacy of blood flow produces a very similar pain, although it is likely to be less severe and will not last very long-perhaps minutes rather than hours. This type of pain is commonly called “angina”.