Although many readers have asked me to discuss the subject of angina pectoris in these articles, I have refrained from doing so largely because there is very little that is constructive that can be said. About the only cheerful aspect of the topic that I know is, that if you reach the age of 65 it is unlikely that you will suffer from it.
But you will suffer with so many other things that that itself is rather cold comfort. The only reason for doubting that the case of Gotama Buddha was actually angina, is that the Gotama was 80 years old at the time the attack occurred.
The reason for this is that true angina probably is due either to a spasm of the vessels which supply the heart muscle, the coronary arteries, or to a blood clot forming in these vessels. The consequence in either case is that a certain amount of the heart muscle is cut off from nourishment, and the pain which accompanies the attack is a warning that the heart cannot do its work well and that rest must be taken.
Now, these coronary vessels begin to close up and disappear fairly early in life. By injecting them with a solution which will throw a shadow on the x-ray, it is possible to see the amount of the coronary circulation in any given case, and such photographs have been made over and over again of hearts of people in different ages, and they show with great uniformity the fact that the blood supply of the heart begins to diminish at about the age of 40. The fact is that it begins to diminish at about the age of 20, but the change is not particularly striking until the fourth and fifth decade.
In hearts at this age we find that the blood vessels which supply the muscle of the right side of the heart have disappeared to the extent of about 50 per cent. Later on, the left side becomes equally impoverished. In fact, in many cases of very aged people who die in old people’s homes or alms houses, it is impossible to find any blood vessels which go to the heart at all, and nourishment seems to take place by the diffusion of the blood from the heart chambers to the muscle.
In this demonstration we have the reason for the occurrence of angina pectoris in middle age, and its disappearance in advanced age. It is easy to see that with a blood vessel which is becoming thicker, less elastic, narrowing its opening, that blood would clot inside such a vessel, and it is this which is the cause of the symptom, angina. If this process occurs rapidly in the years around 50, the closing of the vessel may be fatal, because it cuts off nourishment from a portion of the heart muscle which has not had a chance to protect itself. If, however, we have the process practically completed without accident, then in the ages above 65 and 70, the closure of these vessels is not fraught with such severe penalties.
The study of the degeneration of the blood supply to the heart is also a potent lesson to those who feel that by a strenuous exercise they can, in middle life, recover the health and spirits of youth. Too strenuous exercise, as a matter of fact, is more harmful to these people, and may bring on an attack of angina which otherwise would not occur. There is a limitation to the amount of re-invigoration that can be accomplished in middle age which is imposed by just this change in the blood supply to the heart, and if more middle-aged people would read the lesson correctly, it would do much to decrease the rapidly mounting mortality from heart disease in the United States.