DEAR DR. DONOHUE: I have an unusual problem, and I would deeply appreciate your helping me to better understand it. I had been having chest pain, which I thought might indicate heart trouble. The pain lasted only a few minutes and always happened when I was sitting and relaxed. My wife took me to the emergency room the last time it happened. They worked me over for a heart attack. I didn’t have one. All tests were normal. They made an appointment for me with a heart doctor. He says I have variant angina and put me on medication. How serious is this? — L.H.

ANSWER: Variant angina is a somewhat-rare kind of chest pain. It comes on when people are at rest, just as you said. The more common kind of angina comes on with activity and comes about because heart arteries are clogged with cholesterol buildup. Too little blood gets to the heart to support the physical activity. Variant angina produces similar pain. It surfaces at rest because heart arteries go into a spasm and cut off blood flow to the heart.

Variant angina is nothing to fluff off. It can be deadly. The initial three to six months of variant angina are the time of greatest danger. After that, the condition is much less threatening.

Treatment is medicines that keep heart arteries dilated. Mostly they are nitrates, like nitroglycerin, the tablet put under the tongue to relieve ordinary chest pain. It breaks the heart artery spasm. Long-acting nitrates also are available. The drug family that includes diltiazem also can stave off variant angina attacks.

After 12 to 16 months of treatment, the dose of medicine can be reduced and eventually stopped if no recurrences have occurred.

TO READERS: Asthma questions are coming in a flood. Readers who would like more information on that common ailment can order the asthma booklet. It provides a description of the illness and its treatment. To obtain a copy, write: Dr. Donohue — No. 602, 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: Yesterday I started seeing double. If I close one eye, everything is normal. Is this an emergency? Should I see an eye doctor right away? If I can get by as I am, will this just wear off? — M.J.

ANSWER: See an eye doctor as soon as possible. Some very serious conditions can produce double vision.

Seeing a double image when both eyes are open points to trouble either with the nerves that control eye muscles or with the eye muscles themselves. Within the eye socket are six muscles that turn the eye in all directions. Three nerves coming from the brain supply those muscles. Diabetes, thyroid gland troubles and an illness called myasthenia gravis are some of the disorders that can interfere with the nerves or muscles and disrupt eye alignment. The result is double vision.

Sometimes double vision disappears on its own. In other cases, treatment is mandatory. If there is an untreatable condition, special lenses can restore single vision.

DEAR DR. DONOHUE: At age 45, I had my uterus removed because of heavy bleeding. Ever since, I have seen the same gynecologist who performed the surgery. He never bothered with Pap smears. He retired, and my new doctor wants me to have Pap smears. I am 70. Do you think this is necessary? — L.G.

ANSWER: The purpose of Pap smears is detection of cervical cancer. The cervix is the lowermost part of the uterus, the part that projects into the vagina. If the uterus and vagina have been removed for reasons other than cancer, Pap smears can stop. Some doctors, however, might want to continue to perform pelvic exams.

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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