Unstable Angina

(or: Angina Monologue)

I'm writing this page to inform friends about my "incident" this past week. The short story is that I was diagnosed on Monday, Nov. 18 with unstable angina, which is caused by a blockage of blood in the coronary artery. I was admitted to Stanford Hospital that afternoon, got hooked up to all kinds of monitors and given blood thinners, and prepared for procedures on Tuesday. An angiogram showed blockage in the left circumflex coronary artery. It was almost totally blocked. The doctors then performed angioplasty to expand the blocked area and placed a stent (23 x 3.5 mm) in that area. I felt good almost instantly. After another night in the hospital for observation, I was sent home on Wednesday. I am supposed to take it easy for a few days, will have a treadmill test in a week, and if I pass the test, can resume normal activity (rock climbing!). Many thanks for your concern!

Now, here is the longer version, including events leading to it. I offer it in the hope that even people with apparently low risk should be on the alert for such things.

Background: Here are a few things about me: I'm about to turn 50 in December. I exercise regularly and vigorously. I eat well (lots of fish, red meat maybe once a week), I drink moderately, I do not smoke, I am not overweight. I have never had serious illness. I have no known history of heart disease in my family. People who know me say that I'm pretty much a specimen of good health.

Symptoms: About a month ago, I woke up in the early morning between 4:00 and 5:00 with a heaviness in my chest. I felt a bit short of breath, but after about 5 minutes, the symptoms went away, and I fell back asleep. Over the next week, this recurred until it became an almost nightly event (but never more than once per night). At that point, I thought I might have heartburn, so I went and got some antacid tablets, but that did not seem to help. I still did not suspect that it would be my heart, especially because it was not correlated with physical activity, and because I considered myself fit (though the thought of athletes having fatal heart attacks did cross my mind).

The following week, I was playing tennis, and about 5 minutes into playing, I felt the same heaviness in my chest. Weird, I thought, but I kept playing, and the symptoms went away -- I played for almost 2 hours, and things felt normal afterwards. Each time I played tennis, though, this same sequence occurred, but again, because the symptom did not become severe, I just ignored them.

The same symptoms started showing up when I went to the climbing gym starting a couple of weeks ago. (Climbing especially in the gym tends not to be aerobically demanding). I especially felt it when I was doing some difficult crux bouldering moves, but the symptoms would go away quickly.

Then last Thursday, while I was in Washington, I was walking up a moderate hill (up Connecticut Avenue from Dupont Circle to the Washington Hilton where Ronald Reagan was shot) when I felt the symptom, and I got pretty worried because it's such a mild hill -- in fact the thought occurred to me that I might collapse there, thought it would be ironic if I collapsed in the same spot where Reagan was shot -- but as soon as I stopped walking, the symptom went away. I spent the rest of the day moving about delicately and worrying about what the heck was going on.

The following day, I took an early flight home, and when I got back, drove immediately to urgent care at the Palo Alto Medical Foundation and reported my symptoms.

Treatment: At urgent care, they gave me an EKG, determined that I was not having a heart attack, but said that they suspected angina, talked to the cardiologist on call who would schedule a treadmill test the next week, gave me some pills and told me to check in with my primary physician the following Monday (with whom I had conveniently already scheduled an appointment).

Early Monday morning, I went to my primary, and as soon as I told him about my symptoms, the alarm bells went off, and he immediately sprang over to the cardiologist, scheduled a treadmill test and an ultrasound of the heart. I did that test, and on the treadmill managed to replicate the symptoms of chest pain, and when they did the ultrasound, did not see anything particularly alarming. The cardiologist quickly looked at the results, and told me to come back at 1:30 to hear more about my symptoms and review the results. So, I felt somewhat relieved that he was sending me away, but also a bit concerned that he did tell me to come back. In any event, I went back to work, caught the tail end of a dissertation orals that I'd missed, taught a class, had my research group meeting, and then went back to the cardiologist.

My wife (Nancy) met me there. I described my symptoms, and he reviewed the treadmill results. Without hesitation he declared that I had unstable angina, which is distinguished from regular angina by changes in symptom and discomfort at rest (e.g., when I'm sleeping), and that the aggressive thing to do would be for me to go directly to the hospital and have an angiogram and, assuming he found what he suspected, an angioplasty. He felt that I should not even drive myself over there, so we left one car at the clinic and Nancy drove me to Stanford Hospital.

At Stanford Hospital, they did not mess around. They gave me the room to report to, told me not to bother even registering at the hospital, and once there, they pumped me full of anticoagulants to prevent heart attack. I had all kinds of wires and tubes, I felt bionic (I guess I am fortunate that until then, I had never had an IV in my life, so I was kind of having an out-of-body experience).

The procedure itself was fascinating and absorbing, because you get to stay awake, watch it on a monitor, and talk with the doctors. There is an X-ray camera across the chest, and when the die is injected, the entire artery system appears clearly on the monitor. It's pretty amazing watching your own heart beating, the ultimate in narcissism! The blockage was clearly visitble on the circumflex coronary artery where the blood flow tapered off to what looked like less an a half-millimeter (the scale was the probe which the doctor told me was 3 mm). Once identified, they moved on quickly to do the angioplasty (balloon) procedure. Just before inflating the balloon, they told me to expect a replication of the same chest discomfort because it momentarily restricts blood flow through the same area, and sure enough, I felt the same chest discomfort as they did it. Then - voila - another injection of the die showed that the blocked area was now open. The doctor then asked for a 23 x 3.5 mm stent and inserted that, which also took just a minute or two, again accompanied by the chest discomfort. And that was it! The whole thing probably took less than 45 minutes, with most of the time spent on prepping.

By the way, my friend Ludi Billings sent me his work website which does analyses of stents, and there is a movie, which is available at their website, it shows just about exactly what they did to me (but only check this out if you have a fast connection) Check out: http://www.marc.com/Solutions/Assets/SOLN_31/TheStentStory3.mpg it is really cool (Thanks, Ludi!)

So that's about it for now. I go back for my treadmill test in a week, and hopefully at that time, they will give me the green light to get back to full physical activity. I feel that I just renewed my lease on life, and I'm thankful for everyone who shared their thoughts and prayers.

Kenji Hakuta

November 21, 2002