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Dx Angina/ Chest Pain Treatment:


SUMMARY: When there is chest pain and a myocardial infarction is suspected:
*(1)take an aspirin
*(2)take previously prescribed medications for angina: nitrates, beta-blockers, calcium channel blockers
*(3) go immediately to a hospital where tPA may be prescribed before or concurrent with radiological and surgical intervention.
*(4) In ST-elevation myocardial infarction and unstable angina, there is "at present (2006) no solid evidence for survival benefit on early [surgical] invasive strategy;" initial use of "tPA has more favorable outcomes."
*(5) Testosterone decreases angina and may improve the cardiac healing response after myocardial infarction." Channer states that there is "The protective effect of testosterone on myocardial ischaemia is maintained throughout treatment without decrement."
*(6) There are no studies of the use of testosterone, intravenous or topical, in the Emergency Room in men with angina. [Editor] Although it seems to make sense.

Angina Pectoris/ Chest Pain

The Merck Manual Home Edition
"Angina, also called angina pectoris, is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen.
*A person with angina has discomfort or pressure beneath the breastbone (sternum).
*Angina typically occurs in response to exertion and is relieved by rest. Doctors diagnose angina based on symptoms, electrocardiography, and imaging tests.
*Treatment may include nitrates, beta-blockers, calcium channel blockers, and percutaneous coronary intervention or coronary artery bypass graft surgery.
*In the United States, approximately 10 million people have angina, and it is newly diagnosed in about 500,000 people each year. Angina tends to develop in women at a later age than in men.

Usually, angina occurs when the heart's workload (and need for oxygen) exceeds the ability of the coronary arteries to supply an adequate amount of blood to the heart. Coronary blood flow can be limited when the arteries are narrowed. Narrowing usually results from fatty deposits in the arteries (atherosclerosis—see Atherosclerosis) but may result from coronary artery spasm. Inadequate blood flow to any tissue is termed ischemia.

When angina is due to atherosclerosis, it usually first occurs during physical exertion or emotional distress, which make the heart work harder and increase its need for oxygen. If the artery is narrowed enough (usually by more than 70%), angina can occur even at rest, when the demands on the heart are at their minimum."

*[Editor] Every man over the age of 45 and woman over the age of 60 should have a Coronary Artery Calcium Score (C.A.C.S.). This is a 30-second rapid C.T. scan of the chest that documents the presence, size, and volume of calcification. If he/she has calcification C.A.C.S. strongly predicted future major adverse cardiac events." On the positive side, having a score of zero or even a C.A.C.S. score less than 100, says the John Hopkins group, "will find that individual is at virtually no risk of having a heart attack and "for older individuals without calcium in their arteries, it means they do not need routinely prescribed cholesterol lowering medications or aspirin because they are at a lower risk of a heart attack."

Medications Used in the Treatment:
1. Beta Blockers: metoprolol, Toprol® XL, Tenormin®, etc.
2. Calcium Channel Blockers: Norvasc®, Cardizem®, Cardizem®LA, Caduet,etc.
3. Anticoagulants: Fragmin®.
4. Nitrates: Nitrostat®, isosorbide, etc.
5. Arteriolar Vasodilators: amyl nitrite.
6. Anti-anginals: Ranexa®.
7. Androgens: Testosterone (men).
8. Prescription Supplements: Vitamins, Minerals, Co-enzyme Q10, carnitine, selenium, iodine, omega-3

*[Editor] The British Andrology Group treat men with Low-T with and without heart disease. They establish that testosterone replacement (injections not creams/gels) not only strengthen the heart muscle, improves ejection fraction, but also dilates the coronary arteries.

*[Editor] Based on the above research, it might be prudent to apply a larger quantity of testosterone gel while awaiting the ambulance.

*See Andropause: Low Testosterone (Low-T) and Video Andropause: Testosterone Deficiency and Diseases in men. The reference article by K.S. Channer explains the cardiac and life-promoting benefits of testosterone for men.
Channer states "Other studies of acute intravenous testosterone therapy have demonstrated increased cardiac output mediated by a reduction in the systemic vascular resistance and increased ischaemic threshold in men with CAD. Clinical trials have demonstrated that chronic and physiological dose testosterone supplementation significantly improves anginal symptoms and the time to electro-cardiographic ischaemia on exercise treadmill testing, an effect which is proposed to be mediated by testosterone's vasodilatory action."

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