Whenever a patient complains of left sided chest pain, arm pain or jaw pain, First ask yourself- is it related to Heart?
Suspect Angina whenever:
1. Pain is experienced on left side of chest or retrosternally. 2. If pain radiates to Left jaw, left shoulder or medical aspect of left arm. 3. If pain appears on exertion and disappears on rest. 4. Confirmary test is disappearance of pain with sublingual sorbitrate.
Avoid Exertion:
If possible change to sedentary job. In particular avoid sudden exertions like running to catch bus, moving furniture in house, climbing stairs in a hurry etc.
Reduce weight if overweight.
Low fat diet. Use sunflower oil for cooking.
Coronary vasodilators:
Nitrate or Dilitiazem or both. Tab. ISORDIL 10 mg tds & S.O.S. or Tab ISmo-20 1 bd or Tab. Dilzem 30mg. 1 tds.
Anti Thrombotics:
Tab. Dynasprin 1 bd (Aspirin + dipyridamole) or Tab. Disprin ½ OD + Tab. PERSANTIN 1 bd.
Angina can be a typical, with pain only in epigastrium or left lower jaw or left shoulder and arm. The confirmatory test is immediate relief with sublingual Isodril.
If anginal pain persists even after taking sorbitrate, think of Myocardial Infarct.
If a toothache in left lower molar persists even after tooth extraction. Think of Angina.
It is wiser to detect angina early and refer for investigations and Bypass surgery, that to wait till an infarct develops. At the same time, if the patient cannot afford Bypass surgery at all, then there is no point in spending on stress test and coronary angiography.
