( By Dr Ramesh Kapadia )

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Fear Of Death

Coronary Heart Disease is notorious for killing the victim in an instant. Angina occurring for the first time, angina at rest, and the frequent episodes of angina not responding satisfactorily to nitrates require intensive medical, and if necessary even surgical treatment. However, the fear of death with every episode of angina is out of the place. Fear leads to the narrowing of the coronary arteries and increase in viscosity of blood which may aggravate angia. Longer the standing of chronic angina, the greater is the establishment of collateral circulation. Moreover, in the patients of chronic angina the heart muscle gets conditioned to ischoemia.

A clinical assessment of angina in a given individual is a very complex problem which requires consideration of several factors - age, sex, family history, personal habits like smoking, alchohol and regularity in taking prescribed medicines, etc. The decision regarding the management has to be highly individualised. No general rule of the thumb is possible. Moreover, a final word is not yet written on the management of coronary heart disease and the differences of opinion amongst the experts are common. Doctor-patient relationship and faith in the doctor play an important role.

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