DEAR DR. DONOHUE: Will you explain the cause of spasmal angina when there is no blockage in the heart artery?

I have episodes of angina pain. – H.

ANSWER: You’re speaking of Prinzmetal’s angina, also called variant angina. It’s the same kind of angina chest pain that happens to people with one or more clogged heart arteries, but clogged arteries aren’t the problem.

Regular angina occurs when a person is active, up and about. The chest pain stops when the person stops whatever he or she might be doing.

Prinzmetal’s angina takes place when a person is at rest. The pain lasts only a few minutes and goes away on its own.

In regular angina, the pain occurs because heart muscle isn’t getting enough blood to support the extra demands placed on the heart when a person physically exerts him- or herself.

A partially obstructed heart artery doesn’t allow more blood to flow to the heart muscle, and it reacts with chest pain. The obstruction is plaque, a buildup of cholesterol, fat, blood platelets and protein that clings to and infiltrates the artery wall.

In Prinzmetal’s angina, the obstruction is a sudden artery spasm that constricts the artery.

All arteries are encircled by bands of muscle that narrow the arteries when they contract and expand them when they relax. In Prinzmetal’s, those muscles constrict when they shouldn’t, and they do so for no good reason and unpredictably. The result to heart muscle is the same as in regular angina – too little blood getting to heart muscle.

The outlook for this illness is good. In the first six months of the condition, angina occurs more frequently than it does as time passes. The episodes tend to become fewer and fewer.

Medicines used for regular angina, like nitroglycerin, are also used for Prinzmetal’s angina. The booklet on coronary artery disease deals with regular angina, one of medicine’s most common problems. Readers can order a copy by writing: Dr. Donohue – No. 101, Box 536475, Orlando, FL 32853-6475.

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a woman in her mid-40s with significant bone loss (osteopenia). I was completely unaware that bone loss can occur in premenopausal women. I was stunned by my poor bone-density score. Why doesn’t the medical community inform the public that bone loss can be an issue for premenopausal women? – E.M.

ANSWER: Osteoporosis happens mainly to women after menopause, when there is a sudden and precipitous drop in their production of estrogen, the female hormone that works to preserve bone health.

However, women attain their peak bone strength in their late 20s and early 30s. From that time on, bones begin to lose their calcium and become more fragile. Osteoporosis can occur at younger ages. You don’t have osteoporosis. You have osteopenia. It’s a marker on the road to osteoporosis.

At young ages, girls should be on a program of building a bank deposit of calcium and strong bones by meeting the daily requirements for calcium and vitamin D, and by not doing things that lead to bone demineralization, like smoking. Daily exercise is another requirement for strong bones.

DEAR DR. DONOHUE: I never had unprotected sex. I have always used a condom. Should I have an AIDS test to be sure I never acquired the AIDS virus? I haven’t had intercourse since 1986. How effective are condoms in preventing it? – S.M.

ANSWER: Condom use greatly lowers the probability of transmitting and acquiring the AIDS virus. In couples — one of whom carries the virus and the other does not – condom use reduces the transmission rate by 80 percent. The only safer way of preventing AIDS is abstinence.

Not having any symptoms of AIDS in 22 years of no contact all but assures you of not being infected.

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. Readers may also order health newsletters from www.rbmamall.com

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