Angioplasty, also known as percutaneous transluminal angioplasty, means changing the shape of a blood vessel. In balloon angioplasty, a thin catheter is passed through an artery in the leg up the main artery in the abdomen, the aorta, into the heart, and the tip inserted into the affected coronary artery, under X-ray control.

The tip of the catheter is passed through the narrowed section (which has been identified by a previous coronary angiogram). Just short of the tip, the catheter forms a tiny balloon, which is inflated once it is exactly opposite the narrowed segment of artery. This compresses the atheromatous plaque back into the wall of the artery, widening it. After angioplasty, the blood flow through that section of artery is usually multiplied many times.

Original doubts about angioplasty have been cast aside, now that many thousands of people have been treated, and the successes have been obvious. It works best for those with single-vessel disease who fail to respond to medical therapy. It has a greater than 90 percent success rate in coronary arteries, and many angina patients feel much better immediately after it is done. The risk of restenosis is 25 to 40 percent and greater the first six months after the procedure.

Angioplasty is performed under local anesthesia and moderate sedation, so that you will be hazily conscious throughout it. It is performed in the operating room, however, with an anesthetist on hand, so that on the very rare occasions that the catheter causes angina, the team can swing into a full bypass operation.

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So what should we conclude about alcohol and angina? Can angina sufferers have the occasional drink? My feeling is that they can, but it has to be under strict control. I would restrict drinking to the odd glass of wine with meals, and I still recommend abstention for three days a week. If you also have high blood pressure, then I would go further and advise only the very occasional drink as a treat.

A final word about alcohol. Probably the busiest times of the year for family doctors are the days after a national holiday such as Christmas Day, New Year’s Eve, or Thanksgiving. Special occasions for a family, such as a birthday, anniversary, wedding, or reunion, provide the same circumstances. At times like these, people overeat, usually a meal full of fat, and overdrink. Inhibitions are lost, everyone is very happy, and they go to bed full of food and drink.

During the night, all the conditions for shutting down the blood flow through a coronary artery are fulfilled. The extra fat in the bloodstream makes the blood more viscous, and the flow more sluggish. The blood is more likely to clot. The alcohol that you have drunk ensures that the blood pressure remains just a little higher than usual, and the strain on the plaque sitting in your coronary artery is a little greater. The result, in the small morning hours, may well be a heart attack.

I hate to be a killjoy, but if you have taken the trouble to change your lifestyle to protect your heart, it is a pity to throw all the advantages away just because of one night of overindulgence. You can enjoy a party much better sober than you can even a little drunk, and think of how much better you will feel in the morning.

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The best exercise to start with is simply to walk. This is the exercise that benefits your health with the least fuss. Whatever your age and occupation, you can “take our hearts for a walk.” You don’t have to walk far or fast to begin with. The initial aim is to walk for up to twenty minutes three times a week.

You can do it by walking to work or the shops, or walk, rather than drive, to the train station. Don’t make yourself suffer in bad weather; you won’t keep it up, and it may put you off the idea of walking. If you normally catch a bus, get off a stop or two before your own stop, and walk the rest of the way. If you have a dog, take it for a walk yourself, rather than telling the children to do so. Walk on weekends, with the family, to the park, or on a trail.

Whenever you can, climb stairs rather than use the elevator. Walk, rather than drive, to any destination within a mile of your home. Even throw away the remote control of your television set, so that you have to get up to change the program! Do things, rather than watch television, in your spare time. If you do stay at home, try gardening or doing the odd jobs needed around the house.

If you feel you can’t keep up your new activities, recognize that it’s always easier to start something new than to keep it going. That is why you must choose an activity that you like, then start it gently and increase it slowly. Don’t despair if you backslide on a particular exercise. Start again, and keep on starting, because your heart will benefit every time that you do.

Once you have started on the exercise program, you will soon begin to feel better. You will be carrying less weight around, which will be less work for your heart for the same exercise—the demand side of that supply-demand equation is getting better. Your heart and muscles will be working more efficiently with the training, and your circulation will be improving. So where do you go from here?

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However, not all educational projects have succeeded like the Finnish one. The WHO (World Health Organization) European Collaborative Trial was an attempt to prevent coronary heart disease using factory-based health education. The subjects were 49,781 men aged forty to fifty-nine years, working in forty-four pairs of factories in Britain, Belgium, Italy, Spain, and Poland. The health education message was given to everyone working at the treatment factories, and not to those in the control factories.

Over all, after six years, there was an average reduction in coronary heart disease risk of 11 percent, and an average reduction of 8 percent in actual deaths from coronary disease, in the treatment factories compared to the control factories. However, the different countries varied in their success rates. The best successes were in Italy and Belgium, and in Britain there was no benefit at all, except in that by the end of the study fewer men were smoking.

The Belgian results were particularly interesting, in that the men in the treatment factories with angina and an abnormal EKG at the start of the study showed the greatest proportionate decrease in heart attacks. In the control factories, the heart attack rates in such men were 138 per 1,000 men; in the treatment factories, they were 63 per 1,000. This meant that the health education message was halving the heart attack rate in the men at highest risk—and this should be an encouragement to any reader with angina.

Why were the Belgians so different from the British? It is hardly likely that they are genetically different. Are British factory workers less likely to listen to a health message than their Belgian colleagues, or was the message not put across in a satisfactory way by the researchers in Britain? The answer is unclear, but one message from that trial was that a considerable effort is needed to make major changes in a society.

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The heart should beat efficiently, be in peak condition, and have smooth, wide blood vessels that supply it with enough oxygen and glucose to deal with any demand put upon it, without clotting or sticking. For this to happen, the blood itself must be in peak condition.

Blood is certainly thicker than water, and it contains within it a blend of substances and cells that makes it much less than free-flowing.

First, there is the serum, the watery fluid in which all the constituents of the blood float. It carries minerals, salts, and glucose—all the soluble substances needed for the continuing health of the tissues and organs, and the waste products that need disposing of through the kidneys.

Then there is the plasma, which is the name given to the serum plus a mixture of proteins and fats, mainly derived from food. Cholesterol and related fatty-protein compounds, the lipoproteins, are part of the plasma. Very fatty plasma, high in cholesterol, is more viscous than normal, it is sticky to the touch, like the stickiness left after frying food in a pan.

Whole blood is plasma plus the cells—the solid constituents. They include the white cells (leukocytes), which act to resist infection and inflammation; platelets, fragments of cells that initiate clotting in arteries; and the red blood cells (erythrocytes) that transport oxygen around the body.

A fluid engineer would be horrified to be asked to design a pump for a closed system of wide and narrow tubes filled with such a mixture of solid, fatty, and watery substances. The difficulties in calculating the various pressures and flow rates are huge. For example, in each blood constituent—serum, plasma, and cells—there are substances that can make it much more viscous. As a fluid becomes stickier, the pressure needed to push it through a small tube becomes much higher, and that means a much greater effort from the heart. The demand of the myocardium for oxygen rises steeply.

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