DEAR DR. DONOHUE: I have had several episodes of chest pain, and some woke me from sleep. I had a normal stress test. My doctor wants me to have a heart catheterization. He thinks my heart arteries are normal but that I have variant angina. What is that? – P.O.

Angina – chest pain that comes on with exertion and leaves with rest – is almost always due to a buildup of gunk on heart artery walls. The buildup obstructs flow of blood to the heart muscle. When people who have such an obstruction are physically active, their heart muscle needs more blood to support the activity. It can’t get it, and the result is chest pain. That’s regular angina.

There’s another kind of angina that is a bit odd. It comes on with rest, and it often comes on during sleep and wakens people. The basic problem is the same as in regular angina – a deficient supply of blood to the heart muscle. But here, the cause of the deficiency is not a buildup of gunk, but a sudden spasm of the heart artery. The spasm is so severe that it cuts off blood flow to heart muscle.

This is variant angina. Proof that it is the source of chest pain is obtained when a person has an episode of pain while an electrocardiogram is being taken. The ECG shows a specific change that identifies variant angina as being the problem. However it is all but impossible to obtain an ECG at the moment a patient happens to have chest pain.

A heart catheterization can provide the answer. When the catheter is inched into the heart arteries, an injection of a certain drug will cause artery spasm in people with variant angina. The spasm is seen on X-rays taken at the moment of injection.

Treatment for variant angina, also called Prinzmetal’s angina, includes nitroglycerin and calcium-channel blockers. Both medicines are used for regular angina. The outlook for variant angina is favorable.

The pamphlet on coronary (heart) artery disease gives a full presentation on common angina. Readers can order a copy by writing: Dr. Donohue – No. 101, P.O. Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have heartburn, and I also have osteoporosis. My doctor wants me to take Fosamax for osteoporosis, but I am afraid to do so. Fosamax can irritate the esophagus, and I don’t need the double irritation of heartburn and the medicine. What would you do? – E.R.

Fosamax and other members of the same drug category have proven to be powerful remedies for osteoporosis. Fosamax can irritate the esophagus if it gets stuck there on its way to the stomach. The manufacturer, therefore, tells all users to take the medicine in the morning with a full glass of water 30 minutes before eating. It also tells people not to lie down during those 30 minutes. Taken in this way, Fosamax won’t get stuck in the esophagus, and it will be optimally absorbed. (It should not be chewed.)

If you follow directions, the drug won’t harm your esophagus, and it won’t add to the irritation you suffer from heartburn. Did you know that Fosamax comes in a newer tablet that is taken only once a week?

Why aren’t you doing something for your heartburn?

DEAR DR. DONOHUE: Please provide the facts on honey. I hear it is good for arthritis and cancer. I am a bit suspicious of those claims. Is it a sugar? – M.M.

Honey is a carbohydrate. It is composed of fructose (fruit sugar), glucose (the sugar used in intravenous solutions for hospitalized patients) and a bit of sucrose (table sugar). One tablespoon of honey has more carbohydrate calories than does a tablespoon of sugar: 64 vs. 50.

Honey has some antioxidant properties, protecting cells from the noxious byproducts of body metabolism. It doesn’t cure arthritis or prevent cancer. Use it if you like it and if it fits into your daily scheme of carbohydrates and calories.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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