( By Dr Ramesh Kapadia )

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Chronic Angina

Chronic stable angina is a fairly common manifestatoin of the coronary disease. Most patients with chronic angina can lead a very useful life with the help of the nitrate group of drugs. Angina is chronic when it occurs after a particular mental or physical stress or a heavy meal and is relieved instantly with some rest or a nitrate pill under the tongue. Such angina is rarely fatal. Only in a few cases chronic angina is so severe that it may require treatment with angioplasty or bypass surgery.

More than 200 years ago Dr. John Hunter, a very famous British surgeon, suffered from chronic angina. At that time nitrate was available in a capsule form, to be broken in a handkerchief and its vapour inhaled through the nose to relieve the chest pain. John Hunter lived a very busy life with angina for 40 years. One day he was requested by the superintendent of a hospital to be present at an interview where a lady doctor was to be selected for the post of Obstetrician and Gynaecologist. Looking through the files of the applicants, one of the candidates was found most deserving for the post. The Superintendent along with Dr. Hunter and another colleague decided to select that person. In course of the interview somebody rbought in a small note for the Superintendent which he read and slipped quietly into his pocket. When all the interviews were over and a decision was to be taken, the Superintendent, who was also the chairperson, suddenly changed the decision. Seeing that he was influenced by that note, Dr. Hunter burst out in great anger, and throwing the file on the floor dashed out of the board room and dropped dead outside. During his lifetime Dr. John Hunter used to say, "My life is in the hands of the hooligans who choose to irritate me. When I die, you should look at my heart; the arteries supplying blood to my heart would have hardened like a rock."

Dr. Hunter's wish was honoured. On examining his heart after his death, it was seen that the arteries had hardened. Hunter's heart is preserved in the Royal College of Surgeon Museum at London and below it is the inscription relating the above story. The story has two lessons. Chronic angina is compatible with a long useful existence, and a sudden burst of emotions, speciall anger, can be a death-blow to the heart.

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