A. As a family doc I know that your dads diagnosis of angina doesn't only affect him, but the whole family. Its important that all of you have your questions answered.
ANGINA PECTORIS, according to the dictionary, is a "severe constricting pain in the chest, often radiating to the left shoulder and down the arm, due to ischemia (reduced blood supply) of the heart muscle, usually caused by coronary disease (disease of the arteries supplying blood to the heart)."
Basically, angina is just that: a severe pain in the chest (often described not as pain but as pressure, squeezing, heaviness or choking). We tend to classify angina as stable, when we can predict what will bring on the pain (walking uphill, shovelling snow, other effort-needing activities), or unstable when it changes from its usual pattern of predictability, occurs at rest, or is generally increasing in severity and frequency.
The classic explanation for these symptoms is pretty simple. The heart, like any other organ in the body, needs blood to supply oxygen to it, so it can work. This is accomplished through arteries. Those arteries that supply blood to the heart are called coronary arteries. In any situation where the oxygen-need, or demand of the heart exceeds the oxygen-supply, the muscles of the heart, well, kind of scream out in pain, so to speak.
So why should there ever be a demand too great for the supply? Again, continuing our classic example, our person is probably a 55 year old man with any number of risk factors for heart disease. What these factors have combined to do over the years, in a slow but steady way, is to contribute to atherosclerosis, a narrowing of the coronary arteries. True, when our friend is out shovelling the snow, his heart needs to work harder. In order to do so it needs more oxygen. But the narrowings of the coronary arteries are such that only so much oxygen-rich blood can get through so fast. If his demand becomes too great for the supply, he gets pain in his chest, angina, which signals the distress of his heart muscles. Luckily, if he stops shovelling his pain will stop. It's when an artery gets totally blocked all of a sudden, or if the muscle of the heart cannot recover from its lack of oxygen that we see heart attack.
So no, angina is not really caused by stress, but yes, stress CAN actually bring on the pain of angina, once the underlying atherosclerosis is established.
As for your dad, there are some things he can do to help reduce his risk of heart attack, some of which include exercise programs, lifestyle changes, and medications. Sounds like he already has a good family doc who will be able to advise him well. I hope this helps you understand angina a bit better.
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