Where is angina pain typically felt. What are the main types of angina. How is angina diagnosed and treated. What lifestyle changes can help manage angina symptoms.

Understanding Angina: The Basics of Heart-Related Chest Pain

Angina is a form of chest pain that occurs when the heart muscle doesn’t receive enough oxygen-rich blood. This condition can manifest in various ways and is often a symptom of underlying heart disease. To better understand angina, it’s crucial to explore its types, symptoms, and potential causes.

Types of Angina

There are four main types of angina:

• Stable angina: The most common type, triggered by physical activity or stress
• Unstable angina: Can occur at rest and may indicate an impending heart attack
• Microvascular angina: Caused by dysfunction in the smallest coronary arteries
• Prinzmetal’s angina: A rare form caused by sudden tightening of heart arteries

Is one type of angina more serious than others? While all types of angina require medical attention, unstable angina is considered the most critical as it may precede a heart attack and requires immediate medical intervention.

Recognizing Angina Symptoms: Beyond Chest Pain

Angina symptoms can vary from person to person, but typically include:

• Chest discomfort or pain (often described as pressure, squeezing, or fullness)
• Pain that may radiate to the shoulders, arms, neck, jaw, or back
• Shortness of breath
• Fatigue
• Nausea or vomiting
• Sweating
• Dizziness

Can angina symptoms be mistaken for other conditions? Yes, angina symptoms can sometimes be confused with indigestion, heartburn, or muscle strain. This is why it’s crucial to seek medical attention if you experience persistent or recurrent chest discomfort.

Gender Differences in Angina Presentation

Interestingly, angina symptoms can manifest differently in men and women:

Angina in Men

Men typically experience:

• Chest pain or discomfort
• Pain radiating to the shoulders and arms
• Neck pain

Angina in Women

Women may experience:

• Discomfort in the abdomen, neck, jaw, throat, or back
• Shortness of breath
• Nausea
• Fatigue

Why do angina symptoms differ between men and women? The exact reason isn’t fully understood, but it may be related to differences in heart anatomy, hormones, and how nerve signals are processed. Women are more likely to experience microvascular angina, which can present with atypical symptoms.

Unraveling the Causes of Angina

Angina is primarily caused by reduced blood flow to the heart muscle. The most common underlying cause is coronary artery disease (CAD), where plaque buildup narrows the arteries supplying blood to the heart. However, other factors can contribute to angina:

• Coronary artery spasm
• Severe anemia
• Abnormal heart rhythms
• Heart valve disease
• Hypertrophic cardiomyopathy

Can non-cardiac conditions cause chest pain similar to angina? Yes, conditions such as acid reflux, pulmonary embolism, or even anxiety can cause chest pain that mimics angina. This is why a thorough medical evaluation is essential for accurate diagnosis.

Risk Factors: Who’s Most Susceptible to Angina?

Several factors can increase your risk of developing angina:

1. Age (men over 45 and women over 55 are at higher risk)
2. Family history of heart disease
3. Smoking
4. High blood pressure
5. High cholesterol levels
6. Obesity
7. Diabetes
8. Lack of physical activity
9. Chronic stress

How can understanding these risk factors help in preventing angina? By identifying your personal risk factors, you can work with your healthcare provider to develop a targeted prevention strategy, which may include lifestyle modifications and medical interventions.

Diagnosing Angina: A Multi-Faceted Approach

Diagnosing angina involves a combination of medical history review, physical examination, and various diagnostic tests:

Physical Examination and Medical History

Your doctor will ask about your symptoms, risk factors, and family history of heart disease. They will also perform a physical exam to check for signs of heart problems.

Diagnostic Tests

• Electrocardiogram (EKG): Measures the heart’s electrical activity
• Stress tests: Evaluate heart function during exercise
• Blood tests: Check for cardiac enzymes and other markers
• Imaging tests: Such as echocardiograms, CT scans, or MRIs
• Cardiac catheterization and coronary angiography: Provide detailed information about blood flow in the heart

Why are multiple tests often necessary for diagnosing angina? Each test provides different information about heart function and structure. Combined, they offer a comprehensive picture that helps in accurate diagnosis and treatment planning.

Treatment Strategies: Managing Angina Effectively

Angina treatment aims to reduce symptoms, improve quality of life, and prevent complications. The approach typically involves a combination of lifestyle changes, medications, and in some cases, medical procedures:

Lifestyle Modifications

• Quitting smoking
• Adopting a heart-healthy diet
• Regular exercise (as advised by your doctor)
• Stress management techniques
• Maintaining a healthy weight

Medications

Common medications for angina include:

• Nitrates (e.g., nitroglycerin)
• Beta-blockers
• Calcium channel blockers
• Antiplatelet agents (e.g., aspirin)
• Statins (to lower cholesterol)

Medical Procedures

In severe cases or when medications aren’t sufficient, procedures may be necessary:

• Angioplasty and stenting
• Coronary artery bypass grafting (CABG)

How do these treatments work together to manage angina? Lifestyle changes and medications aim to reduce the heart’s workload and improve blood flow, while procedures can physically open blocked arteries. The combination of these approaches provides comprehensive management of angina symptoms and underlying heart disease.

Living with Angina: Strategies for Long-Term Management

Managing angina is an ongoing process that requires active participation from the patient. Here are some strategies for long-term management:

Regular Medical Check-ups

Consistent follow-ups with your healthcare provider are crucial for monitoring your condition and adjusting treatment as needed.

Medication Adherence

Taking prescribed medications as directed is essential for controlling symptoms and preventing complications.

Lifestyle Maintenance

Continuing with heart-healthy lifestyle choices is key to managing angina and reducing the risk of future cardiac events.

Stress Management

Implementing stress reduction techniques such as meditation, deep breathing exercises, or yoga can help manage angina symptoms triggered by stress.

Cardiac Rehabilitation

Participating in a cardiac rehabilitation program can provide supervised exercise, education, and support for living with heart disease.

How can patients effectively track their angina symptoms? Keeping a symptom diary that records the frequency, duration, and triggers of angina episodes can be helpful. This information can assist your doctor in fine-tuning your treatment plan.

Emerging Treatments and Research in Angina Management

The field of cardiology is continually evolving, with new treatments and management strategies for angina being developed. Some areas of current research include:

Novel Medications

Researchers are exploring new drugs that can improve heart function and reduce angina symptoms with fewer side effects.

Gene Therapy

This innovative approach aims to promote the growth of new blood vessels in the heart, potentially improving blood flow and reducing angina symptoms.

Enhanced Imaging Techniques

Advanced imaging technologies are being developed to provide more detailed information about heart function and blood flow, leading to more precise diagnoses and treatment plans.

Personalized Medicine

Tailoring treatments based on an individual’s genetic profile and specific characteristics of their heart disease is an emerging area of focus.

What potential impact could these emerging treatments have on angina management? These advancements could lead to more effective, personalized treatments with fewer side effects, potentially improving quality of life for individuals with angina and reducing the risk of serious cardiac events.

Understanding angina, its symptoms, causes, and treatment options is crucial for anyone experiencing chest pain or at risk of heart disease. By recognizing the signs, seeking prompt medical attention, and actively participating in treatment and lifestyle modifications, individuals can effectively manage angina and reduce their risk of complications. As research continues to advance, we can look forward to even more effective strategies for managing this common but serious condition.

Symptoms, Causes, Diagnosis, and Treatment

What Is Angina?

Angina is chest pain that happens because there isn’t enough blood going to part of your heart. It can feel like a heart attack, with pressure or squeezing in your chest. It’s sometimes called angina pectoris or ischemic chest pain.

It’s a symptom of heart disease, and it happens when something blocks your arteries or there’s not enough blood flow in the arteries that bring oxygen-rich blood to your heart.

Angina usually goes away quickly. Still, it can be a sign of a life-threatening heart problem. It’s important to find out what’s going on and what you can do to avoid a heart attack.

Usually, medicine and lifestyle changes can control angina. If it’s more severe, you may need surgery, too. Or you may need what’s called a stent, a tiny tube that props open arteries.

There are different types of angina:

Stable angina. This is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn’t a heart attack, but it can be a sign that you’re more likely to have one. Tell your doctor if this happens to you.

Unstable angina. You can have this while you’re at rest or not very active. The pain can be strong and long-lasting, and it may come back again and again. It can be a signal that you’re about to have a heart attack, so see a doctor right away.

Microvascular angina. With this type, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women.

Prinzmetal’s angina (variant angina). This type is rare. It might happen at night while you’re sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.

Angina Symptoms

Chest pain is the symptom, but it affects people differently. You may have:

• Aching
• Burning
• Discomfort
• Dizziness
• Fatigue
• Feeling of fullness in your chest
• Feeling of heaviness or pressure
• Upset stomach or vomiting
• Shortness of breath
• Squeezing
• Sweating

You might mistake an aching or burning for heartburn or gas.

You’re likely to have pain behind your breastbone, which can spread to your shoulders, arms, neck, throat, jaw, or back.

Stable angina often gets better with rest. Unstable angina may not, and it could get worse. It’s an emergency that needs medical help right away.

Angina in Women vs. Men

Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat, or back. You may also have shortness of breath, sweating, or dizziness.

One study found that women were more likely to use the words “pressing” or “crushing” to describe the feeling.

Angina Causes

Angina usually happens because of heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to your heart muscle. This forces your heart to work with less oxygen. That causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks.

Less common causes of chest pain include:

Angina Risk Factors

Some things about you or your lifestyle could put you at higher risk of angina, including:

Angina Diagnosis

Your doctor will do a physical exam and ask about your symptoms, risk factors, and family history. They might need to do tests including:

• EKG. This test measures your heart’s electrical activity and rhythm.
• Stress test. This checks how your heart is working while you exercise.
• Blood tests. Your doctor will check for proteins called troponins. Lots of them are released when your heart muscle is damaged, as in a heart attack. Your doctor may also do more general tests like a metabolic panel or complete blood count (CBC).
• Imaging tests. Chest X-rays can rule out other things that might be causing your chest pain, like lung conditions. Echocardiograms and CT and MRI scans can create images of your heart to help your doctor spot problems.
• Cardiac catheterization. Your doctor inserts a long, thin tube into an artery in your leg and threads it up to your heart to check your blood flow and pressure.
• Coronary angiography. Your doctor injects dye into the blood vessels of your heart. The dye shows up on an X-ray, creating an image of your blood vessels. They may do this procedure during cardiac catheterization.

Angina questions for your doctor

• Do I need any more tests?
• What type of angina do I have?
• Do I have heart damage?
• What treatment do you recommend?
• How will it make me feel?
• What can I do to try to prevent a heart attack?
• Are there activities I shouldn’t do?
• Will changing my diet help?

Angina Treatment

Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine and lifestyle changes can often help their blood flow better and control their symptoms.

Medicines

Your doctor might prescribe medicines including:

• Nitrates or calcium channel blockers to relax and widen blood vessels, letting more blood flow to your heart
• Beta-blockers to slow your heart down so it doesn’t have to work as hard
• Blood thinners or antiplatelet medications to prevent blood clots
• Statins to lower your cholesterol levels and stabilize plaque

Cardiac procedures

If meds aren’t enough, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:

Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again.

The procedure usually takes less than 2 hours. You’ll probably stay overnight at the hospital.

Coronary artery bypass grafting (CABG), or bypass surgery. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.

You can expect to stay in the hospital about a week after you have this. You’ll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. You’ll then move to a regular room to recover.

Enhanced external counterpulsation

Enhanced external counterpulsation (EECP) may be an option to relieve your angina. Your doctor may recommend it if other treatments haven’t worked or aren’t right for you.

EECP uses several blood pressure cuffs on both legs to gently, but firmly, compress the blood vessels there to boost blood flow to your heart. Each wave is timed to your heartbeat. So more blood goes there when it’s relaxing.

When your heart pumps again, pressure is released right away. This lets blood be pumped more easily. It can help your blood vessels make a natural bypass around narrowed or blocked arteries that cause your chest pain. It may help some small blood vessels in your heart open. They may give more blood flow to your heart muscle to help ease your chest pain.

You might have EECP if you:

• Have chronic stable chest pain
• Aren’t helped by nitrates, calcium channel blockers, and beta-blockers
• Invasive procedures like bypass surgery, angioplasty, or stenting aren’t right for you.

EECP isn’t invasive. If you’re accepted for EECP treatment, you’ll have 35 hours of therapy. It’s given 1 to 2 hours a day, 5 days a week, for 7 weeks. Studies have shown its benefits include less need for anti-anginal medicine, fewer symptoms, and the ability to be more active without symptoms

Lifestyle changes

You can still be active, but it’s important to listen to your body. If you feel pain, stop what you’re doing and rest. Know what triggers your angina, like stress or intense exercise. Try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often. If you still feel pain, talk to your doctor about having more tests or changing your medications. Because angina can be a sign of something dangerous, it’s important to get checked out.

These lifestyle tips may help protect your heart:

If you smoke, stop. It can damage your blood vessels and increase your heart disease risk.

Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. When those are out of normal range, your chance for heart disease can rise. Eat mainly fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.

Use stress-relieving measures like meditation, deep breathing, or yoga to relax.

Exercise most days of the week.

See your doctor regularly.

If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Quick treatment is very important. It can protect you from more damage.

Angina Outlook

Angina raises your risk of having a heart attack. But it’s treatable. Consider it a warning sign and make healthy choices.

Talk with others who have it. That may help you learn how to feel better.

Your family, too, may need support to help them understand your angina. They’ll want to know what they can do to help.

Pericarditis (Pericardial Disease): Symptoms, Causes, Diagnosis, Treatment

Pericardial disease, or pericarditis, is inflammation of any of the layers of the pericardium. The pericardium is a thin tissue sac that surrounds the heart and consists of:

• Visceral pericardium — an inner layer that envelopes the entire heart
• A middle fluid layer to prevent friction between the visceral pericardium and parietal pericardium
• Parietal pericardium — an outer layer made of fibrous tissue

What Causes Pericarditis?

Causes of pericarditis include:

For some people, no cause can be found.

Pericarditis can be acute (occurring suddenly) or chronic (long-standing).

What Are the Symptoms of Pericarditis?

When present, symptoms of pericarditis may include:

• Chest pain. This pain is frequently sharp and located in the center of the chest. The pain may radiate to the neck and shoulders, and occasionally, the arms and back. It can be made worse when lying down, coughing, or swallowing and may be relieved by sitting forward.
• Low-grade fever.
• Increased heart rate.

How Is Pericarditis Diagnosed?

Your doctor can diagnose pericarditis based on:

• Reported symptoms
• Electrocardiogram (EKG or ECG) results
• Echocardiogram
• Cardiac MRI
• Physical exam

Other tests may be performed to determine the cause of pericarditis.

What Is the Treatment for Pericarditis?

Treatment of pericarditis is based on the cause and may include:

• Nonsteroidal anti-inflammatory agents (NSAIDs) to decrease the pain and inflammation
• Steroids, used occasionally for severe attacks
• Antibiotics, if the pericarditis is due to infection
• Colchicine, particularly if symptoms last for several weeks or occur on a repetitive basis

Most patients recover from pericarditis in two to four weeks.

What Is Constrictive Pericarditis?

Constrictive pericarditis occurs when the pericardium becomes thickened and scarred. This can make it difficult for the heart to expand with blood.

What Are the Symptoms of Constrictive Pericarditis?

The symptoms of constrictive pericarditis are the same as pericarditis, with the addition of:

How Is Constrictive Pericarditis Diagnosed?

The same tests used to diagnose pericarditis are used to diagnose constrictive pericarditis. Other diagnostic tests used for constrictive pericarditis include:

• Echocardiogram
• Cardiac catheterization
• MRI
• CT scan

How Is Constrictive Pericarditis Treated?

Treatment of constrictive pericarditis may include:

• Analgesics and anti-inflammatory agents to treat pain or inflammation
• Diuretics to treat heart failure symptoms
• Antiarrhythmics to treat any abnormal heart rhythms, such as atrial fibrillation
• Pericardiectomy (the surgical removal of the stiff pericardium from the heart)

What Are The Symptoms of A Heart Attack?

Most Common Symptoms

The most common warning signs of a heart attack include the following:

Chest Pain

Most heart attacks involve pain or discomfort in the center or left-center of your chest. This pain can range from mild to severe.

The pain may feel like tightness, fullness, heavy pressure, crushing, or squeezing. It can also feel like heartburn or indigestion.

Chest pain usually lasts more than a few minutes. Sometimes it goes away and comes back, with exertion making it worse and rest making it better.

Upper Body Discomfort

You may also feel pain or discomfort in your arms, jaw, neck, back (especially between your shoulders), or upper part of your stomach (above your belly button).

Sometimes, pain begins in your chest and then spreads to these other areas of your upper body.

Shortness of Breath

You may experience trouble breathing or the sensation of being winded when you’re at rest or doing very slight activity that wouldn’t normally cause breathlessness. Outside of chest pain, shortness of breath is one of the most common warning signs of a heart attack.

This may be the only symptom you experience, or it can happen before or along with chest or upper body pain. (1,2)

Other Common Symptoms

Other common warning signs that may signal a heart attack include:

• Light-headedness or sudden dizziness
• Cold sweat or clammy skin
• Nausea and vomiting
• Heart flutter or palpitations (especially in women)
• Cough (especially in women)
• Heartburn (especially in women)
• Sleep disturbances (especially in women)
• Anxiety (especially in women)
• Extreme fatigue or exhaustion (may occur for days or even weeks leading up to a heart attack, especially in women) (1,2,3,4)

Silent Heart Attack Symptoms

Sometimes a heart attack doesn’t cause obvious symptoms. This is known as a silent heart attack.

Still, a silent heart attack may offer some warning signs, even if they’re brief and mild. These typically include variations on classic heart attack symptoms, such as:

• Chest discomfort that lasts a few minutes, or comes and goes
• Discomfort in your neck, jaw, arms, back, or stomach
• Shortness of breath
• Cold sweat
• Nausea
• Light-headedness (5)

Silent heart attacks are more common in women than in men. (4)

What to Do During a Heart Attack

A heart attack is a medical emergency.

The faster you get to a hospital, the better your chances of surviving the heart attack and minimizing damage to your heart muscle.

Even if you’re not sure your symptoms indicate a heart attack, you should seek emergency medical care. Never worry about a false alarm or causing anyone embarrassment.

Follow these steps if you or someone around you is having heart attack symptoms:

Call 911 Immediately

Don’t wait more than five minutes before calling for help.

If you take nitroglycerin for chest pain that comes on with exertion and goes away with rest, take it immediately.

If your chest pain doesn’t go away within five minutes, call 911.

An ambulance is the best way to get to the hospital, since you can be monitored and start treatments while on your way.

If you cannot call 911 for some reason, have someone drive you to the hospital.

Never drive yourself unless there is absolutely no other choice. (1,2)

Chew One Aspirin if Recommended

After you call 911, the operator may tell you to take an aspirin.

Aspirin may help to slow or reduce clotting and blockage around the site of a ruptured plaque deposit in your artery. This can limit damage to your heart and help save your life.

But aspirin won’t cure a heart attack or make your symptoms go away, so never delay calling 911 to take an aspirin.

You may be told not to take aspirin if you take a medication that can interact with it. (1,2)

Sit Down and Stay Calm

Try to relax and remain calm while you wait for help to arrive.

If you’re at home alone, open the front door and sit on the floor near the entrance.

This will help the paramedics easily find you in case you lose consciousness before the ambulance arrives, and give them a flat surface on which to begin CPR if necessary.

Note the Time

If you’re able to do so, record the time your heart attack symptoms began and what you were doing when they started.

This information may help the doctors treating you when you reach the hospital.

Additional reporting by Quinn Phillips.

Heart Attack Symptoms, Risk, and Recovery

What is a heart attack?

A heart attack, also called a myocardial infarction, happens when a part of the heart muscle doesn’t get enough blood.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle.

Coronary artery disease (CAD) is the main cause of heart attack. A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle.

What are the symptoms of heart attack?

The major symptoms of a heart attack are

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Feeling weak, light-headed, or faint. You may also break out into a cold sweat.
• Pain or discomfort in the jaw, neck, or back.
• Pain or discomfort in one or both arms or shoulders.
• Shortness of breath. This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort.

Other symptoms of a heart attack could include unusual or unexplained tiredness and nausea or vomiting. Women are more likely to have these other symptoms. Learn more about women and heart disease.

Call 9-1-1 if you notice symptoms of a heart attack.

If you notice the symptoms of a heart attack in yourself or someone else, call 9-1-1 immediately. The sooner you get to an emergency room, the sooner you can get treatment to reduce the amount of damage to the heart muscle. At the hospital, health care professionals can run tests to find out if a heart attack is happening and decide the best treatment.

In some cases, a heart attack requires cardiopulmonary resuscitation (CPR) or an electrical shock (defibrillation) to the heart to get the heart pumping again. Bystanders trained to use CPR or a defibrillator may be able to help until emergency medical personnel arrive.

Remember, the chances of surviving a heart attack are better the sooner emergency treatment begins.

How a doctor decides it could be a heart attack

Patients with chest pain come to my clinic with a nervous expression and a million-dollar question, “Doctor, is it my heart?”

Such concern is valid. But understanding how medical providers think about chest pain may allay some fear.

If you come to a clinic with chest pain, your provider will have questions about the major factors for heart disease. I will ask if you:

• smoke (the number one preventable risk factor)
• have diabetes
• have high cholesterol
• have high blood pressure
• assess your age and gender
• check to see if you have a family history of heart disease.

Symptoms for a heart attack

I also will be looking to see how closely your symptoms resemble the typical signs of a heart attack:

• Character: Heart pain is a dull, pressure-like sensation—”an elephant sitting on my chest.” If the pain is aching, sharp, burning or stabbing, the cause may be a condition like acid reflux or heartburn, pleurisy, costochondritis or aortic dissection.
• Location: Your heart is on the left side of your chest so any pain in this area is suspect. If the pain is on the right side, then a heart attack is unlikely (unless you have a rare condition called dextrocardia). Pain from a heart attack typically feels like vague and non-localizable. If your pain has a pinpoint location then it is unlikely to be a heart attack. Be aware: because of how nerves in that area of your body overlap, heart-related pain can occur at the left side of the neck and the left arm. We call this referred pain.
• Timing/duration:  Heart attack pain can be intermittent or continuous. Heart attack symptoms can last for a few minutes to a few hours. If you have had chest pain continuously for several days, weeks or months, then it is unlikely to be caused by a heart attack.
• Things that make your symptoms worse or better:  Heart attack pain is usually relieved by rest since your heart is not as active during rest (unless your heart attack is massive, in which case it will persist with rest). If your chest pain is aggravated by other factors, such as food intake in the case of acid reflux, or pressing on the affected area in the case of muscular/bony chest wall pain—then your doctor may look for other non-heart-related causes of your chest pain symptoms.
• Other factors: Although shortness of breath typically accompanies a heart attack, the presence of this symptom may lead your provider to check your lungs as well. Symptoms such as fever, chills and coughing up of yellow-greenish phlegm are not typically associated with heart attacks (unless you have pneumonia on top of a heart attack).

The challenge of identifying the cause of chest pain symptoms can be complex. That’s why if you do have chest pain seek medical attention immediately rather than checking Google for answers. Matters of the heart are often more than a mouse-click away.

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Microvascular Angina: Why Women Shouldn’t Ignore Chest Pain and Fatigue

A sharp twinge, a sense of heaviness — we’ve all felt chest pain from time to time. Sometimes it’s indigestion or a panic attack. But other times, it’s more serious.

Microvascular angina is an especially worrisome source of cardiac chest pain, and it’s often misdiagnosed because it doesn’t show up as a blockage in the larger heart arteries during testing. This fact can cause doctors to miss the underlying cause.

“It’s concerning because the problem can be missed. It doesn’t show up on a traditional angiogram, which can lead to delayed diagnosis if physicians dismiss the chest pain as nothing,” says Erin Michos, M.D., associate director of preventive cardiology at the Ciccarone Center for the Prevention of Heart Disease. 

This chest pain in one of the heart’s arteries is more common in women than in men, says Michos.

What Is Microvascular Angina?

Angina is any chest pain that occurs when your heart muscle doesn’t get enough blood to meet its work demand, a condition called ischemia. 

The most common source of angina is obstructive coronary disease, which happens when one of the heart’s arteries is blocked. People with this type of angina might feel chest pain during exercise or exertion if not enough blood is supplied to the working heart muscle. 

But according to the American Heart Association, up to 50 percent of women with angina symptoms don’t have a blocked artery. In fact, they may not even have chest pain, though they may have other symptoms. 

“They may feel severely short of breath. They might feel extreme fatigue, which rest doesn’t make better. They may have pain with exertion in their back, jaw or arm with no chest pain. They might have nausea and indigestion,” says Michos.

These women should be evaluated for microvascular angina. Microvascular angina can occur when the heart’s tiniest arteries are not able to supply enough oxygen-rich blood due to spasm or cellular dysfunction. 

It can be difficult to diagnose microvascular angina because an angiogram — a specialized X-ray of the heart — won’t show obstruction or blockages in these tiny arteries, and symptoms like nausea and indigestion mimic other illnesses. Often, your doctor will perform a stress test to monitor the heart’s function during exercise to make a diagnosis. 

When the diagnosis is uncertain after a typical stress test, there are advanced tests that can be performed to evaluate for microvascular disease. This includes a special type of stress test using cardiac MRI or a technique performed at the time of an angiogram to test for dysfunction in the heart’s arteries when a usual blockage isn’t found. 

Treating Microvascular Angina

Because microvascular angina affects tiny arteries, surgical treatments that can be used on larger arteries are not an option. However, medications can reduce symptoms and improve heart health. Medications prescribed for microvascular angina include: 

• Nitroglycerin, which dilates and relaxes arteries to prevent spasms
• Beta blockers, which slow heart rate
• Statins, which can slow the progression of fatty plaque in the arteries
• Calcium channel blockers, which help relax blood vessels

Preventing Microvascular Angina

Women with microvascular angina have increased rates of stroke, heart attack and heart failure. While treatment can help reduce the risk of these complications, “the best intervention is prevention,” says Michos. 

It’s important to know your risk. “Traditional risk factors, like smoking and diabetes, that lead to blockages in the larger arteries are also risk factors for microvascular angina,” adds Michos. High blood pressure, high cholesterol and high body mass index also increase risk.

Lifestyle choices, like a healthy diet and moderate exercise, can address many of these risk factors and lower your chances of getting microvascular angina. It’s also important not to be shy about bringing up chest pain or other symptoms with your doctor.

“Women with chest pain often dismiss it. They think heart disease is a man’s disease, or that it’s indigestion or stress. The biggest thing is to create awareness that angina can happen without obstructive disease and that it’s risky,” Michos says.

Heart Attack and Conditions That Mimic Heart Attack: Learn About Chest Pain

There are many medical conditions that can mimic a heart attack. Some of these are a sign of something urgent, and others are not. Remember, if you are experiencing symptoms of a heart attack, dial 911. A few possible non-heart-attack causes of chest pain are described below. Your physician can help you identify the cause of any chest pain. There are other causes of chest pain that relate to the heart as well as non-heart-related causes of chest pain. You can learn about many of the causes of chest pain here, but first it is important to learn about heart attack and conditions that mimic it.

What Is a Heart Attack?

A heart attack happens when a complete blockage suddenly forms in an artery that supplies blood to your heart (a coronary artery). Blockages are caused by a disease process throughout the arteries in your body called atherosclerosis, in which plaque (a fatty substance) builds up in the arteries. This plaque narrows the arteries, leaving less room for blood to flow. A plaque can be topped with a thin, fibrous cap that ruptures. With rupture, exposure of atherosclerotic debris to the bloodstream can cause platelets (a component of blood that assists with clotting) and red blood cells to collect at the site of the rupture, cutting off blood flow to the artery. Alternatively, part of the plaque may break off and flow downstream in the blood. This piece of plaque can then lodge in a narrowed portion of the artery and blood will begin to clot around it. This blood clot (thrombosis) can partially or completely cut off blood flow through the artery. When blood flow is cut off, this is called ischemia.

A heart attack is an emergency that requires immediate medical attention. Here’s why:

Your heart is a muscle. Blood carries vital oxygen and nutrients to the heart muscle, and without blood, the heart muscle begins to die. That is why every second counts when it comes to heart attack treatment. An extensive blockage, especially in a major blood vessel, such as the left anterior descending artery, can cause a large heart attack. Large heart attacks that are not treated early and aggressively can lead to heart failure. The risk of death within five years of being diagnosed with certain types of heart failure can be 50 percent or more, worse than many forms of cancer.

It is better to go to the hospital and learn that you are not having a heart attack than to stay home and have one. That’s because the consequences of an untreated heart attack are so great. If your symptoms persist for more than 15 minutes, you are at more risk that heart muscle cells will die. It is critical for you and your heart that you receive immediate medical attention. To receive the best care, you have about 90 minutes from the onset of the heart attack for an interventional cardiologist or surgeon to restore the flow of blood to the heart before critical heart tissue dies or is damaged.

Know that today your chances of surviving a heart attack – and surviving it well – are greater than ever, and that patients and physicians are a team working together for heart health. Recognition of the symptoms of a heart attack and seeking prompt medical attention are crucial in improving one’s odds of surviving a heart attack, so the first and probably most important link in the battle against CAD is seeking PROMPT medical attention when there is any suspicion of a heart attack.

Symptoms of Heart Attack

Many heart attacks involve discomfort in the center of the chest that lasts longer than a few minutes or that goes away and comes back. It can feel like –

• Uncomfortable pressure,
• Squeezing,
• Fullness, or
• Stabbing pain.

However, NOT ALL HEART ATTACKS ARE PRECEDED BY CHEST PAIN.

 Heart attack symptoms include –

• Chest discomfort
• Discomfort in other areas of the upper body:  one or both arms, the back, neck, jaw or stomach
• Shortness of breath with or without chest discomfort
• Pounding heart or changes in heart rhythm
• Heartburn, nausea, vomiting, abdominal pain
• Breaking out in a cold sweat
• Dizziness or lightheadedness

Heart Attack Symptoms May Be Different in Women

These heart attack symptoms are more common in women. They may occur without chest pain.  

• Sudden onset of weakness,
• Shortness of breath
• Nausea, vomiting, indigestion
• Body aches
• Overall feeling of illness
• Unusual feeling or mild discomfort in the back, chest, arm, neck or jaw (Remember, these may occur without chest pain and still be a heart attack)
• Sleep disturbance

People who have diabetes or are elderly may also experience atypical heart attack symptoms.

If you or someone you are with experiences any of the symptoms above, get help immediately. Don’t delay. 

In a heart attack, every second counts. Dial 911 to get to the hospital as soon as possible.

If you can, chew an uncoated aspirin tablet. This can help slow blood clot formation while you wait for emergency medical technicians (EMTs) to arrive in an ambulance.

Unstable Angina

Angina is chest pain caused by a lack of blood flow to the heart due to narrowed or blocked heart arteries. Most commonly it is the result of coronary artery disease (CAD). Angina occurs when the heart is not getting as much blood and oxygen as it needs to pump. Angina that occurs with increasing frequency, with decreasing levels of physical activity, at rest or that is not relieved with rest is called unstable angina. Unstable angina requires immediate attention because it can be the first sign of a heart attack. In unstable angina, blood work that assesses for damage to the heart muscle is negative, indicating no heart attack (yet). Generally, at rest, there is still some blood flow beyond a severe blockage, and so there has not been damage to the heart.

Stable Angina

Angina that occurs with exercise and is relieved with rest is called stable angina. In stable angina, the stimulus that causes the chest pain is relatively stable and reproducible. For instance, a patient with stable angina may report that he or she gets chest pressure with walking ten minutes on the treadmill, that the chest pressure is relieved with rest, and that the symptoms have been relatively stable for the past several months. Additionally, the patient may report that he or she can easily do some activities at home, such as walking one mile slowly, but that increasing the level of exercise by walking faster brings on chest pain.

The chest pain is a sign that blood flow to the heart is being restricted by build-up of plaque (a fatty substance) in the coronary arteries that supply blood to the heart. While a patient with stable angina is not likely to be at immediate risk for a heart attack, the condition does need to be treated. Medications and lifestyle changes will be part of treatment. If the angina is very painful, the patient may consider angioplasty to reopen the narrowed arteries or cardiac bypass graft surgery to reroute blood flow around the blocked blood vessels.

Broken Heart Syndrome (Takotsubo Syndrome)

Physicians know that there is something behind the folk idea of a broken heart. Occasionally, a person may arrive in the emergency room with the symptoms of a heart attack, including the presence of cardiac enzymes in the blood that indicate damage to the heart muscle, as well as abnormalities on an electrocardiogram (EKG or ECG). However, no blockages will be discovered in the arteries that supply blood to the heart. Instead, in these patients, the heart’s main pumping chamber, the left ventricle, contracts in an unusual pattern. With contraction, this ventricle will be shaped like a fishing pot used to trap octopuses, the tako-tsubo pot – an observation made by the Japanese physicians who were the first to identify the syndrome. In other words, the bottom of the heart does not squeeze well (akin to the base of the pot) while the top part of the heart does squeeze well (akin to the neck of the pot).

While takotsubo syndrome is not well understood, researchers think the left ventricle may be “stunned” and unable to function because of a surge of stress hormones after the patient experiences a severe emotional or physical trauma, such as a death of a loved one or an automobile accident. The syndrome usually resolves quickly and without lasting damage to the heart, but it can, in very rare cases, be fatal. If you experience signs of a heart attack, dial 911 right away.

You can learn more about Broken Heart Syndrome here.

Esophageal Spasm, Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a condition in which you have chronic heartburn. Esophageal spasm is when your esophagus, the pipe that carries food from your mouth to your stomach, strongly contracts. Either of these conditions can cause chest pain and can be hard to distinguish from a heart attack since the esophagus runs directly behind the heart within the chest. If the symptoms you experience are unusual for you, sudden, and severe, don’t be embarrassed to seek immediate medical attention. It is better to seek treatment and find out you have heartburn than to ignore a potentially fatal heart attack.

Pulmonary Embolism (blood clot in the lung)

Some forms of chest pain may originate from your lungs, rather than your heart. One lung problem, pulmonary embolism, can mimic a heart attack and is equally serious. A pulmonary embolism is a blood clot in an artery in the lungs. This clot cuts off blood flow, and the lung tissue begins to die. A pulmonary embolism is a life-threatening medical emergency that requires immediate treatment.

Aortic Dissection (tear in the wall of the aorta)

The aorta is the main artery that brings blood from the heart to the rest of the body. The wall of the aorta is made of three different layers. If there is a tear in the innermost layer, blood pumped from the heart may push under this flap and separate one layer from another. This separation causes a tearing chest pain that sometimes goes to the back. This tear in the aorta can extend up to the carotid arteries to the brain, back to the coronary arteries of the heart, or down to the arteries of the legs. Aortic dissection may cause stroke, heart attack and death. It is a life-threatening medical emergency that requires immediate treatment.

Musculoskeletal Pain

Sometimes chest pain may be something as simple as a pulled chest muscle. Inflammation in the cartilage that connects the ribs to the breastbone can also feel like a heart attack. If you have sudden chest pain that is causing you concern, you should seek immediate medical treatment to rule out a serious condition.

Psychological Disorders That Can Cause Chest Pain

Panic disorders, anxiety, depression, emotional stress or other psychological disordersmay also cause chest pain. In these psychological disorders, the chest pain is not related to angina or digestive causes but instead seems to be triggered by the emotional stress. Emotional stress is a relatively common cause of chest pain, but it is extremely important that you see your doctor to rule out coronary artery disease (CAD) before attributing your chest pain to psychological disorders, even if you do not have a history of coronary artery disease.

90,000 Which doctor should I go to for heart pain – doctors treating the disease

Moscow cardiologists – latest reviews

The reception went well, everything was fine with me. This is not the first time I have addressed this specialist, I like it. A competent, polite, calm doctor.Svetlana Ruslanovna helps to treat all my chronic diseases. Her recommendations always help me well.

Anna,

05 November 2021

Zafar Madierovich is a rather attentive doctor.During the appointment, the doctor questioned everything and made a preliminary diagnosis, which turned out to be correct. He also sent for an ultrasound scan and prescribed treatment. They received me on time, even a little earlier. I will contact this specialist again after passing the research.

Alice,

08 November 2021

Everything went well.The doctor listened to me, examined me and appointed me to undergo the necessary examinations. Natalya Anatolyevna is attentive, she left a pleasant impression. Enough time has been given to me. I will also come to the doctor’s appointment.

Marina,

05 November 2021

I found this specialist based on reviews and geographically.Competent, polite doctor. Satsita Gilanievna conducted an examination, explained in sufficient detail what drug was prescribed for what. I hope the results will be positive. I was pleased with the reception.

Olga,

09 November 2021

A very good specialist, I really liked it.I will still make an appointment with Veronika Evgenievna. The doctor knows how to listen to the patient. The doctor got acquainted with the results of all my examinations, very competently deciphered my CT scan, put everything on the shelves for me, prescribed treatment, prescribed medicine. I was very pleased. I recommend a specialist.

Marina,

November 11, 2021

I chose a rating specialist.Elmira Manasovna is a good, attentive and polite doctor. At the appointment, the doctor explained everything in an accessible way and prescribed treatment. I liked the reception very much. If necessary, I will recommend this specialist to my friends.

Rais,

09 November 2021

Good, attentive doctor.Zafar Madierovich listened to my complaints, studied the documents, conducted an examination and made recommendations. I was pleased with the reception. An excellent doctor and a good person. I would recommend this specialist to my friends. I will refer to him again, if necessary.

Svetlana,

09 November 2021

Very good cardiologist Orlova, very attentive.Things are good. I like it. At the reception, Elena Mikhailovna corrected the treatment and made recommendations. I chose this specialist based on reviews, place of residence.

Valentine,

November 11, 2021

Elena Anatolyevna is a competent doctor and speaks very intelligently.I am satisfied with everything. For myself, I received a sick leave and prescribed medications. Enough time has been given. If necessary, I will turn to this doctor again.

Alexander,

07 November 2021

There was a house call.The doctor is convincing, knows how to communicate with stubborn patients. Ekaterina Vladimirovna explained everything, recommended hospitalization, prescribed treatment, advised CT. The doctor communicated with the patient positively. She explained everything easily. There were no moments that I didn’t like. I recommend this specialist. I chose this doctor for availability and rating.

Helena,

November 11, 2021

Show 10 reviews of 6323

Rehabilitation after heart surgery / Diseases / Clinic EXPERT

You underwent heart surgery – either coronary artery stenting, or bypass grafting, or both.What does this mean by and large? This means that modern medical technologies have given you a second chance to find a healthy heart, you have good blood supply to the myocardium again, you can again live without heart pain, not be afraid of physical exertion, and our goal is to save this second chance for a healthy heart!

Despite the performed surgical treatment and the improvement of the blood supply to the heart muscle, which should create favorable conditions for the effective restoration of the quality of life of patients, expectations are not met – their ability to work and social activity continue to remain low. Many experts admit that outpatient medical institutions are not sufficiently prepared for the rehabilitation of cardiovascular patients. According to one of the leading cardiologists in St. Petersburg, after hospitalization, such patients often end up in a network of outpatient institutions that are simply not ready to manage them.

because heart disease is chronic and requires constant prevention of relapse!

For example, for 2010-2012. cardiovascular mortality among men 35-74 years old in Germany, Great Britain, Sweden, Belgium, Austria, Italy, Denmark and many other European countries was 100-200 people per 100,000 population. In Russia – more than 1000 people (Circulation, Heart Disease and Stroke Statistics, 2015), which emphasizes the need for rehabilitation and secondary prevention in cardiac patients.

What is rehabilitation and how should it be done?

Rehabilitation – “rehabilis” – lat. restoration of ability.

For whom is cardiac rehabilitation indicated?

• patients with myocardial infarction
• after CABG, MKB
• after stenting
• after valve replacement
• after surgical treatment of arrhythmias

Rehabilitation after heart surgery is a complex of measures of a medical and psychological nature, directed at:

• prevention of further development of the disease
• prevention of disability
• improvement of the quality of life
• preserving the patient’s working capacity
• returning him to social activity

stability of the patient’s clinical condition

Stages of cardiac rehabilitation

There are three stages of rehabilitation after heart surgery and heart attack myocardium:

• I stage – hospital where stenting / shunting is performed according to indications
• II stage – spa treatment
• III stage – outpatient follow-up of the patient after surgery on the heart or heart attack

Especially outpatient (III) stage of rehabilitation is important, since it is the longest in time, and, ultimately, determines the further development of the disease.

And if everything is clear with the first and second stages of rehabilitation – the hospital where the patient was delivered by the ambulance, and, if possible, the sanatorium, then the third stage of rehabilitation, outpatient, the most important for maintaining health in the future, remains on patient choice.

In the EXPERT Clinic you can undergo the third stage of rehabilitation under the supervision of experienced specialists. In rehabilitation, a multidisciplinary approach is always applied, i.e. interaction of specialists in various fields, namely:

• cardiologist-rehabilitation doctor
• neurologist
• psychotherapist
• nutritionist

This provides various types of assistance 90,050 to overcome the consequences of the disease, change lifestyle, reduce the impact of risk factors ; assessment of the need and sufficiency, duration, consistency and effectiveness of the participation of each specialist at each specific point in time during the course of the rehabilitation period.

If necessary, at the Clinic EXPERT you will be consulted by a council of doctors of various profiles.

The third (outpatient) stage

The program “The third stage of cardiac rehabilitation” at the EXPERT Clinic includes:

• appointment with a cardiologist
• Patient school – group sessions with a cardiologist, within the framework of which the problems faced by patients are addressed , and their solutions
• performance according to the indications of ECG, Echo-KG, daily monitoring of ECG and blood pressure
• general blood test, biochemical blood test (lipidogram, coagulogram, electrolytes, homocysteine, CRP, etc.)
• psychological testing
• psychotherapist consultation
• neurologist consultation
• nutritionist consultation
• genetic analysis of all cardiomarkers, including the risk of sudden death, for the patient and his relatives
• genetic analysis of drug doses in the treatment of cardiovascular diseases

Results of cardiac rehabilitation

The positive effects of cardiac rehabilitation at the EXPERT Clinic include:

• Elimination of risk factors for coronary heart disease and reduction of risk in general
• Increased physical activity
• Smoking cessation
• Normalization of blood pressure numbers
• Reducing body weight
• Improvement of lipid profile
• Improvement of carbohydrate metabolism
• Improvement of endothelial function
• Slowing down the development of atherosclerosis and its clinical consequences
• improving the psychophysical state
• mobilizing patients to cooperate in the process of cardiac rehabilitation.

Dynamic (dispensary) observation is the main form of support for patients with chronic diseases on an outpatient basis. And this does not mean monitoring the natural development of the disease, as is, unfortunately, often the case, but carrying out a set of measures for secondary prevention and rehabilitation!

After surgical treatment, the patient is recommended to visit a cardiologist in the first days after discharge!

During the first year, visits to the doctor should be made at intervals every 4 months. Further, it is recommended to visit a cardiologist at least less than 2 times a year.

The goal of rehabilitation after cardiovascular accidents is to restore the physical and psychological health of the patient. Rehabilitation is indicated for all patients in after surgery, regardless of the severity of the condition – both to gain self-confidence and strength, and to minimize the risk of recurrent exacerbation. Therefore, do not run your health and do not let the disease develop! Then you get a chance to prolong life and improve its quality.

Forecast

With the conscientious implementation of the recommendations for the secondary prevention of cardiovascular accidents and respect for their health, 80-90% of patients return to working capacity, social activity and the usual rhythm of life.

In addition, the completion of the rehabilitation course reduces the frequency of readmission and the level of cardiac risks in general. Patients begin to feel better physically.

Frequently asked questions

How long does it take to recover from heart surgery?

How long it will take to restore body functions depends on several factors: the severity of the initial state, age, motivation of the patient.

However, it is necessary to understand that, in fact, rehabilitation lasts for life, because the whole range of measures is aimed not only at restoring physical and psychological strength, but also at 90,049 prevention of repeated exacerbations of the situation. Without constant prophylaxis, diseases of the cardiovascular system are most often exacerbated.

How to help yourself with heart pain? What medicines do you need to carry with you at all times?

If an attack of angina pectoris occurs (pain or burning sensation behind the breastbone, shortness of breath during physical and emotional exertion, the attacks last for several minutes), then it is necessary: ​​

• Stop physical activity, sit down, calm down
• Use nitroglycerin in in the form of a spray (Isoket, Nitromint-spray), two or three doses under the tongue
• if the pain does not stop, then after 3-5 minutes the drug should be repeated
• if the pain has not passed within 15 minutes, follows chew 1 aspirin tablet with water and call an ambulance.

At what level should blood pressure numbers be maintained?

Maintain blood pressure at less than 130/80 mm Hg. High pressure – more than 140/90 mm Hg. Art. – indicates the presence of hypertension. More than 180/110 mm Hg. Art. indicates severe hypertension.

In order not to lose control over blood pressure, it is necessary to take the medications prescribed by the doctor on time! For this:

• use the alarm clock, beep on the phone to remind you
• Keep the tablets next to a toothbrush, razor or other items that you use every day
• Put the tablets in jars with the indication of the time of taking, for this in the pharmacy you can purchase a special box with compartments.

What physical activities are possible?

The amount of physical activity can be increased gradually.

Moderate exercise is possible 6 weeks after surgery , such as vacuuming, walking the dog, morning exercises, hiking and fishing.

After 3 months you can increase your activity – swimming, cycling, bowling, tennis, football. Snow removal or gardening at the dacha is allowed.

Medium intensity outdoor activities of 30 minutes 3 times a week are recommended to maintain wellness , and those patients who are sedentary should start with light exercise programs.

To sexual activity, according to statistics, patients return after 9-14 weeks. An exercise test should be performed under the supervision of a physician. If the doctor does not detect any symptoms of overload, then sexual activity is allowed.

How to eat properly in case of diseases of the heart and blood vessels?

The main goal of dietary nutrition is to reduce the level of atherogenic lipids in the blood in order to stop the development of atherosclerosis. Recommended levels of total cholesterol after heart surgery – less than 4.0 mmol / L, LDL – less than 1.8 mmol / L, TG less than 1.7 mmol / L, HDL for women more than 1.2; for men more than 1.0 mmol / l.

It is recommended to eat fruits and vegetables every day, sometimes lean meat, fish, olive and other oils.Let’s say alcohol in a dose of no more than 2 glasses of red wine per day for men, 1 glass for women. A dietitian doctor will help you draw up a detailed nutritional program.

Treatment of cardiac arrhythmias and conduction disorders – FSBI “NMITs TPM” of the Ministry of Health of Russia

Treatment of cardiac arrhythmias should begin with a diagnosis – in order to successfully eliminate this problem, it is necessary first of all to determine its cause. These can be both certain diseases of the cardiovascular system, and severe stress, significant excess weight, alcohol abuse, tobacco smoking and beverages containing a large amount of substances that irritate the nervous system.

Diagnostics of arrhythmias and other disorders of the heart in our center is carried out using the latest equipment, so the doctor will be able to detect the slightest deviations from the norm and, if necessary, send the patient for additional research. If, for example, atrial fibrillation is detected, the diagnosis does not end there, the doctor will try to find out what caused the interruptions in the work of the heart and will make every effort to eliminate them.

When to see a doctor?

It is very important to see a doctor as soon as possible if you feel that:

• Heart beats too fast or slow, you feel interruptions in its work.
• There was pain and pressure in the chest.
• You are constantly haunted by weakness, drowsiness, the body gets tired unusually quickly.
• There was shortness of breath with little physical exertion.
• Fainting or sudden loss of consciousness has occurred.

There is no need to waste time, disturbances in the rhythm and conduction of the heart can have serious consequences, sometimes irreversible, if treatment is not started immediately.

You may be diagnosed with

• Arrhythmia – the heart beats too irregularly.
• Tachycardia – heart rate too fast.
• Bradycardia – contractions occur less frequently than necessary.
• Extrasystole – premature contraction of the heart or its parts.

Ventricular heart rhythm disturbances can result not only from problems of the cardiovascular or nervous system, but also signal endocrine disease, pathology of the digestive system, and even an insufficient level of potassium in the blood.

It is imperative to exclude disturbances in rhythm and conduction after treatment with diuretics, most of them flush out potassium from the body, thus leading to heart problems.

Treatment of cardiac arrhythmias

Our specialists, having made a diagnosis, try to prescribe the most effective and at the same time gentle treatment. Often, in order for the violation of the conduction of the heart to disappear, it is necessary to pay more attention to the correction of nutrition and lifestyle, and medications become only an auxiliary means.

In addition, if an arrhythmia is detected, the diagnosis should include all possible directions – sometimes, to eliminate problems, it is necessary to correct the functioning of the thyroid gland.In the event that the problem is at the very heart, we are ready to provide any help, including prompt.

Also, our specialists monitor patients after the treatment – if they need preventive, advisory help or check the pacemaker.

Why us?

In such a large city as Moscow, many people offer treatment for arrhythmias. But only in our center you can get advice from not one specialist, but many professionals who work together, providing the most accurate diagnosis and effective disposal of both the symptoms and the causes of the disease.

This page is for informational purposes only. Find out the exact list of the services provided and the specifics of the procedures by phone.

90,000 Epidural versus non-epidural or no analgesia for pain management during labor

What is the problem?

We set out to evaluate the effectiveness of all types of epidural anesthesia (including combined spinal-epidural anesthesia) for the mother and child, compared with non-epidural anesthesia or none at the time of delivery.

Why is this important?

Pain relief is essential for women in labor. Pharmacological methods of pain relief include nitrous oxide inhalation, opioid injections, and local analgesia with epidural anesthesia to provide central blockade. Epidural anesthesia is widely used to relieve pain during labor and involves injecting a local anesthetic into the lower back in close proximity to the nerves that transmit pain.Epidural solutions are administered by bolus injection (large, rapid injection), continuous infusion, or by means of a patient-controlled pump (pump). When used together with opiates, lower concentrations of local anesthetic are required, which allows women to maintain the ability to move around during childbirth and actively participate in them. Combined spinal-epidural anesthesia involves a single injection of a local anesthetic or opiate into the cerebrospinal fluid for rapid onset of pain relief, and an epidural catheter for long-term pain relief.There have been reports of side effects such as itching, drowsiness, chills, and fever. Rare but potentially serious adverse effects of epidural anesthesia may also occur, such as severe, prolonged headache after injection, or nerve damage.

What evidence have we found?

We searched for evidence in April 2017 and identified 40 clinical trials involving over 11,000 women who contributed to this review.Clinical trials have been distinguished by the quality of their methods.

All but six studies compared epidural analgesia with administration of opioid analgesics. Epidural anesthesia can relieve labor pain more effectively than opioids, and most women can be satisfied with an epidural. In general, women who have used an epidural are more likely to need forceps or vacuum extraction to assist in labor than opioid analgesics.However, we did not see this effect in studies conducted after 2005, which more often used lower concentrations of local anesthetic and more modern methods of epidural anesthesia, such as patient-controlled epidural analgesia (PCEA). Epidural anesthesia, compared to opioids, may have little or no effect on the incidence of cesarean sections, prolonged back pain, the impact on the baby at birth, or the number of infants who need to be transferred to the neonatal intensive care unit.

Women who have received an epidural may have urinary problems and may suffer from fever. There are highly variable outcomes such as longer labor, very low blood pressure, and an inability to move for a period of time after birth (motor blockade), probably due to a higher concentration of local anesthetic used in epidural anesthesia or due to the use of an epidural. infusion instead of dosed epidural administration of anesthetic at regular intervals.However, women who received opioid analgesics experienced some side effects, such as breathing so slow that they required oxygen masks, and severe nausea and vomiting. More infants whose mothers received opioids received antidote drugs to counter the effects of opioids. There was no difference between women who received epidural or opioid analgesics for postpartum depression, headache, pruritus, chills, or drowsiness.

Women who received epidural anesthesia reported less pain than women who received placebo or no treatment or acu-stimulation. There were no reports of pain in trials that compared epidural anesthesia with inhalation analgesia or continuous support.

What does this mean?

Epidural anesthesia can reduce pain during labor more effectively than any other form of pain relief and can increase maternal satisfaction with pain relief.However, some women who received an epidural instead of opioid analgesics were more likely to have an assisted vaginal delivery, but this result likely reflects the higher concentrations of local anesthetics traditionally used instead of the lower concentrations of modern local anesthetics for epidural anesthesia. Further research will be useful, using more consistent interventions to reduce adverse outcomes associated with epidural anesthesia.

What medicines help with heart pain?

13 November 2018

What medications help with heart pain?

Pain in the heart is always a signal of danger. The most common diseases of the cardiovascular system – angina pectoris, heart attack, inflammation of the heart – signal themselves with pain. Heart pain can be stabbing, aching, constricting, occurring in a limited area, or spilled in nature.

A distinctive feature of angina pectoris is pressing, burning pain behind the sternum, which radiates to the left arm, scapula, and lower jaw. It usually occurs during physical exertion or emotional stress. According to the doctor’s prescription, the drug nitroglycerin is used to eliminate (relieve) pain, it dilates the vessels that feed the heart, and improves the blood supply to the heart muscle. The effect of it appears quickly, within the first minutes after application. To date, there is no alternative to nitroglycerin, it is a reference drug for the relief of an attack of angina pectoris.

In addition to nitroglycerin – an ambulance for angina pectoris – there are medicines to prevent pain attacks. They need to be taken daily, constantly, without interruption. The optimal drug or their combination can only be selected by a doctor, taking into account the individual characteristics of the patient.

Some patients with heart pain use outdated, ineffective and often dangerous drugs, such as validol and corvalol. They are used by more than one generation of Soviet and then Russian “cores” according to the principle “historically.”But in civilized countries, they are not used, there is no evidence of their clinical efficacy and cannot be, because the components of these drugs do not improve the functioning of the heart. Moreover, they can aggravate, mask the severity of the disease, because the subjective perception of pain changes, it does not seem so strong. But in fact, oxygen starvation of the heart continues and can lead to such a dangerous complication as a heart attack.

If you have heart pain, be sure to see your doctor as soon as possible, only he can establish the correct diagnosis and prescribe effective treatment.

The Pain of Loss, Clive Lewis – Vera Hospice Charitable Foundation

Observations

I never thought that grief was like fear. I’m not scared, but the feelings that I experience are like a sudden fright, the same inner trembling, the same anxiety, constant yawning, it’s hard for me to swallow.

Sometimes it looks like a slight intoxication, sometimes – confusion. As if between the outside world and me there is an invisible, soft, like a blanket, partition.It is difficult for me to perceive what others are saying. Rather, I do not want to listen to their conversations. I’m not interested in what they are talking about. On the other hand, I want them to talk exclusively about me. I hate being alone in a room. Now, if “they” were talking to each other, and not to me. There are moments, they are always unexpected, when something inside me tries to persuade me that everything is not so terrible, not so hopeless. In addition to love, there are other joys in life. After all, I was happy before meeting H.I have many more, as they say, sources of pleasure. Come on, it’s not all bad. I’m a little ashamed of this inner voice, but this seeming relief quickly fades. A sudden jolt of red-hot memory – and all this “common sense” disappears, like a tiny ant disappears in a candle flame. And I am thrown back to tears and misery. “Tears of Magdalene”. Sometimes I prefer these moments of agony, at least they are honest and pure. But this immersion in a sea of ​​self-pity, this nasty sticky-sweet pleasure that you experience while doing so, is disgusting to me.I am aware, even during these attacks, that I distort her image. One has only to revel in these moods for literally a few minutes, and instead of a living woman, I shed tears over the doll. Thank God, the memory of her is so strong (will it always be so strong?) That such minutes pass without leaving visible traces. Her mind was as strong and flexible as a leopard. No passion, no tenderness, no pain could disarm her mind. He sensed the first signs of drooling and sentimentality, jumping up and knocking you off your feet before you had time to figure out what had happened.How many of my soap bubbles she instantly pierced with her sharp pin! I quickly learned not to talk nonsense, except for the sheer pleasure of watching her reaction – and again a hot, red-hot push – to be vulnerable and funny in her eyes. With no one else I was so afraid to seem ridiculous.

And I have never heard from anyone that grief is accompanied by laziness. This does not apply to my work – here the car turns as usual – I am not capable of the slightest effort, it is hard for me not only to write, even to read the letter, why shave in the morning, what difference does it make if my face is smooth or unshaven? They say that an unhappy person wants to be distracted, whatever he wants, just to get away from himself.But it also happens: a person, tired like a dog, wakes up in the middle of the night from the cold, he needs an extra blanket to keep warm, but he would rather lie there all night shaking from the cold than get up and take out this blanket. It is not difficult to understand why a lonely person becomes sloppy and, over time, dirty and disgusting.

However, the question arises: Where is God? This is the most alarming symptom. When you are happy, so happy that you do not need Him, you even feel that turning to Him will only distract you, and if you nevertheless come to your senses and turn to Him with gratitude, He, at least you feel that way, accepts you. with open arms.But try to turn to Him when you are in despair, when all hopes are in vain, and what awaits you? The door slams shut in front of your nose and you hear the key in the lock turn twice, the bolt rattles – and then silence. No more waiting, turn around and go where you came from. The windows are dark. It looks like the house is empty. And it is not known if anyone was there before. Once upon a time it seemed so. And the old belief that the house was inhabited was as strong as it is now – there is no one there. What does it mean? What does His obvious presence mean in times of prosperity and complete absence when you need His help at the most difficult moment of your life?

Today I shared these thoughts with S.He reminded me that the same thing happened with Christ: “Why did you leave me?” I know, but it doesn’t make it easier or clearer. I don’t think there is a danger of losing faith in God. The real danger is the possibility of believing that He is bad. I am not afraid of the fact that I come to the conclusion “it turns out that there is no God!”

The old men obeyed and said: “So be it.” How often a bitter resentment is suppressed by mortal fear, and feigned love, yes, it is feigned, tries to cover up the true feeling of horror.

Yes, the easiest way is to say: there is no God when we need him most, because He does not, He does not exist. But then why does He exist when, to be frank, we can do without Him?

Be that as it may, of one thing I’m sure: marriage was made for me. I will never believe that religion was invented to cover up our unconscious desires and replace sex with it. Because these few years that we were together, we enjoyed love in all its manifestations: times are serious and fun, romantically uplifted and down to earth, sometimes – sometimes dramatic, like a thunderstorm, sometimes – comfortable and cozy, like slippers at home.Not a single grain of body and soul was left unsatisfied. If God replaced love with himself, we, in theory, would have to lose all interest in Him. Who needs a fake if you have an original? But this is not happening. We both knew that besides each other, we needed something else, something that has no name, some vague need. In other words, when lovers are together, they do not need anything else, do not need, for example, read, eat, breathe.

A friend of mine passed away a few years ago, and for a time I had a strong sense of confidence that he would continue to live an even fuller life.I prayed to God that He would give me at least a hundredth part of such confidence after she left. Again, no answer. Locked door, iron curtain, emptiness – absolute zero. “To the one who asks, nothing will be released.” It was stupid to ask. And now, even if a similar feeling of confidence comes to me, I will not trust him. I will think that my prayers caused self-hypnosis, nothing more.

Anyway, I’ll try to stay away from the Spiritualists, I promised her that, she knew a thing or two about this company.

In words, it is easy to fulfill the promises you made to the deceased. But I began to realize that respect for the will of the deceased was a trap. Yesterday, for example, I stopped in time before speaking about some nonsense: she would not like it. It is not fair to others. Soon I will start using “That would be what X would like.” as an instrument of domestic tyranny, her “desires” will become an increasingly transparent cover for my own desires.

I cannot talk about her with the children. As soon as I try to talk about her, I see on their faces not grief, not love, not pity, not fear, but the most fatal of all types of “non-conduction” – shame.Their appearance suggests that I am doing something obscene. They long for me to shut up. I felt the same when, after my mother’s death, my father mentioned her name. I do not blame them. That’s how boys are.

Sometimes I think that shame, the ordinary feeling of awkwardness, senseless embarrassment often interfere more with doing good deeds and just feeling happy than anything. And not only in youth. Are the boys right? What would X herself think of this horrible notebook that I keep returning to? Aren’t these recordings disgusting? Once I read this phrase: “I spent the whole night without sleep, thinking about toothache and insomnia.”This is very similar to life. Part of any suffering is a shadow or reflection of that suffering. The fact is that you are not only suffering, but at the same time you think that you are suffering. Not only do I live every endless day in grief, but every day I live with the thought that every day I live in grief. Maybe these recordings only exacerbate my suffering? They just reinforce the monotonous, like the movement of a mill, the whirling of thoughts around the same thing. But what should I do? I need some medicine, reading is not a strong enough pill.

Writing down all my thoughts (no, only one hundredth), I believe that I am somehow distracted. So I would have made excuses to H. But most likely she would have found a weak link in my defense.

It’s not just boys. The strange product of my loss is that I am fully aware that I am embarrassing to everyone I meet. At work, in a club, on the street, I meet acquaintances who, coming up to me, on the go try to quickly figure out whether to talk to me about “this”. I hate it when they start talking about “it” and I hate it when they avoid it.Some are just trying to evade. R. has been avoiding me for a whole week.

Most of all I like well-mannered young men, almost boys, who come up to me as they come to the dentist’s appointment, blush terribly, try to get rid of as soon as possible, and then, when the most unpleasant thing is behind, quickly and observing decency as much as possible, disappear in the doorway. bar. Maybe people who have lost loved ones should be isolated and placed in special institutions such as a leper colony?

In some, I cause something worse than embarrassment.For them I am the shadow of death itself. Whenever I come across a happy married couple, I know what they think when they look at me: “One of us will someday be in his place.”

At first I was afraid to visit our favorite places where she and I were once happy – our favorite pub, the park. Once I made up my mind as soon as the pilot was sent on a flight after he had been in an accident. To my surprise, it makes no difference. Its absence in these places is no more perceptible than everywhere. It has no attachment to a particular place.I think if you are suddenly forbidden to eat salt, you will not notice the lack of salt in one dish more than in another. The whole process of eating will be different, every day, any food. It is so simple. The whole life process has changed. Its absence is like the sky stretching over everything.

No, this is not entirely true. There is one place where she is especially lacking, and I cannot avoid this place, for it is me, my body. Once it was significant, since it was the body of beloved X. Now my body is an empty house.However, why deceive yourself? I know the time will come, and my body will regain its former importance for me, and I will even forget that something was wrong with it.

Cancer, cancer and cancer. My mother, father, wife. Who’s next, I think. Nevertheless, H., dying of cancer and knowing this, admitted that she no longer feels the same horror. When this became a reality, the very idea and name of the disease to some extent lost its force. And for a while I almost understood her. It is very important. We never experience just Cancer, War or Misfortune (also happiness).We live for one hour, one minute. Ups and downs. The best times are overshadowed by many small misfortunes, and vice versa, the most difficult are brightened up with good happy moments .. We never fully realize the impact of this or that event in our life, we give it a name that is fundamentally wrong. Life itself is ups and downs, the rest is pure idea.

Now it’s hard to believe that we were happy and cheerful when there was no hope left. How long, meaningfully and richly we talked on the last night!

No, we weren’t quite together.There is a border beyond which it is no longer your “flesh”. It is impossible to fully share the weakness, fear and pain of another being. What the other is experiencing is, of course, terrible. Maybe you feel as bad as someone close to you, but I would not particularly trust someone who insists on this. Still, there is a difference. For, speaking of fear, I mean animal fear, mortal horror that grips the entire body before the end, suffocation – the sensations of a rat in a mousetrap. This horror cannot be shared with anyone. Consciousness compassion, body compassion less.At least bodily closeness is familiar to any loving couple. The whole experience of love trains two bodies to experience not identical, but complementary, interconnected, even if opposite, feelings.

We both knew that. I experienced my own, not her suffering, she had her own, not mine. The end of her suffering meant only my coming of age. We went further each our own way. This chilling truth, this terrible rule of traffic (“You, madam, to the right, and you, sir, to the left”) is just the beginning of separation, which is death itself.This separation awaits everyone. I wondered why we were so fatally unlucky with her, we were separated. But I suppose all lovers think so to themselves when they find themselves in the same situation.

Once she said to me: “Even if we die on the same day and at one hour, lying side by side, it will still be the same separation that you are so afraid of.” Of course, she didn’t know more than I did. But she was closer to death, and it was easier for her to hit the target. She often quoted: “One you came into this world and one you will leave.” And she said that she felt it…. And it would be absolutely incredible if it were different. We were brought together by time, space and flesh, we communicated with each other, like over telephone wires, if you cut one wire, the connection is interrupted. Anyway, should our conversation ever be interrupted? Unless we assume that this type of connection is being replaced by a completely different one, but achieving the same goal. The question is, why was it necessary to destroy the old method?

God is not a clown who pulls out from under his nose. a bowl of soup to immediately slip in another bowl of the same soup.Even nature does not arrange such tricks, it never repeats the same melody twice.

It is very difficult to endure those who say: “There is no death” or “Death does not matter.” Death is and it matters, and its consequences are inevitable and irreparable. You might as well say: Birth doesn’t matter.

I look at the night sky. I am not so sure of anything as that I will never again, in no time and space, see her face, hear her voice, touch her.She died. She is dead. Is it really that hard to understand?

I don’t have a single good photo of her left. When I try to remember her face, I fail to see it clearly in my imagination. But the face of a complete stranger, flashing in the morning crowd, I see with unmistakable precision, as soon as I close my eyes. There is undoubtedly a simple explanation for this. We see the faces of those who are closer and dearer to us than everyone else, in different situations, at different angles, in different lighting, with different expressions, we see them when they walk, sleep, cry, eat, talk, think – and all these different expressions are mixed in our memory and merge into a vague blur.But I hear her voice so clearly. Sometimes, remembering her voice, I can burst into tears like a little child.

2

For the first time during this time, I decided to re-read my notes. I felt unpleasant. Reading these notes, one might think that her death does not matter in itself, but only how it affected me is important. X herself seemed to have dropped out of sight. How could I forget with what bitterness she exclaimed: “How much there is still everything for which I so want to live!”

Happiness came to her rather late.She could live another 1000 years and never get bored. Her taste for all the pleasures of feeling, mind and spirit was never dulled. She enjoyed all the pleasures of life like no one else I knew. She was like a hungry man who was given abundant food and immediately taken away. Rock, fate (or whatever it is called) loves to give great opportunities in order to then deceive expectations. Beethoven went deaf … No matter how you look, it all looks like a cruel joke, the trick of an evil cretin.

I have to think more about H.and less to yourself. That sounds good. But there is a catch. I think about her all the time. I remember how she looked, how she talked, how she moved. But all these facts and details are selected and sorted by my mind. Less than a month has passed since her death, and I already feel that the slow process of transformation of living X into the woman I have invented has begun. And this is an undeniable fact. I will not invent anything else (at least I hope). But what if my notes are still more and more focused on my person? There is no longer the reality itself, which could pull me down in time, as it did, always unexpectedly, living X, being itself, and not me.

The most valuable gift that my marriage gave me is that there was always a being next to me, very close, closely related to me and at the same time different from me and even resisting, in a word – reality itself. Will all this work go down the drain? Am I going to allow X to go further and further until it becomes nothing more than one of the dreams that I had when I was young, when I was not yet married?

Oh, my dear, come back even for a minute and drive away this terrible ghost! Oh, Lord, why did You put so much effort to pull this creature out of its shell, if it is being pulled in, sucked back?

Today I had to meet a man whom I have not seen for 10 years.All these years I thought that I remember him perfectly – his appearance, manner of speaking, his favorite words. But in the first five minutes, the real person completely destroyed the image living in my memory. This does not mean that he has changed a lot. On the contrary, I was mentally saying to myself: “Yes, of course, of course, I just forgot that he was thinking about how he did not like what he knew about this or his way of throwing his head back.” But his appearance has faded and faded in my memory over these 10 years, and when I saw a real person, I was amazed at the amazing difference.Can I hope that this will not happen to my memory of X.? That it hasn’t started already? Slowly, silently, as snow flakes fall to the ground, and the snow will go all night – flakes of my imagination, my selective memory will cover her image … And in the end they will completely bury the real outlines. Just 10 minutes, 10 seconds – and a real, live X could fix everything. But even if I were given these 10 seconds, the next second the flakes will start falling again. And the sharp, rough, purifying taste of her uniqueness will disappear again.

What a pitiful hypocrisy to say, “She will live forever in your memory.” Live? That is exactly what she will not live. With the same success, you can, like the ancient Egyptians, embalm the deceased and think that he will always be with us. What else can convince us that they are not there, they are gone, disappeared forever? What’s left? A corpse, a memory, and (in some variants) a ghost. All this is mockery and horror. Three different words that mean one thing: she died. I loved H. I do not want to love my memory of her, her image that exists in my own imagination.It will be something like incest.

I well remember how unpleasantly struck I was one fine morning many years ago. A full-blooded, cheerful hard worker with a shovel and a watering can in his hands entered the church yard and, closing the gate behind him, shouted over his shoulder to his friends: “I’ll be back soon, I’ll just visit my mother!” He meant that he would water the flowers and clean up his mother’s grave. All this horrified me, such a manifestation of feelings, all this cemetery nonsense, is always and still hateful to me and completely unacceptable to me.

But in the light of my present thoughts, I begin to think: if some (I – not) can accept and understand the behavior of this guy, then perhaps there is a lot to be said in defense of such a position. The 6-by-8-foot flower bed has become a mother, a symbol, that connects him to her. Taking care of the grave means visiting Mom. Maybe this is in some way better than keeping and fondling the image captured in my imagination, in my memory? The grave or the image, in principle, is the same: the threads connecting with the irreversible, symbols of the unimaginable.In addition, the mental image has an additional drawback – it does whatever you want, it will smile or frown, be gentle, cheerful, rude, can argue with you – it all depends on your mood. You are the puppeteer pulling the strings. Of course, this is not entirely true. The memory is still fresh, genuine involuntary memories, thank God, arise unexpectedly and pull the strings out of my hands. But the fatal subordination of the image, the complete dependence on me, will increase over time. On the other hand, the grave bed is a stubborn, stubborn, often intractable part of reality, which, I have no doubt, his mother was during her lifetime.By the way, the same was X.

Or there is. Can I honestly say that I believe that she is? Most of my acquaintances, with whom I meet, say, at work, are sure that she is no longer there. Naturally, they do not share this point of view with me, at least not yet. What do I think myself? I have always prayed for the peace of the souls of people close to me, I pray for them now. But as soon as I try to pray for H., something stops me. Confusion and confusion overwhelm me, I feel the unreality of what is happening, as if I am pronouncing words into emptiness, and everything I talk about is a figment of my imagination.The explanation is quite simple. You never know how much you believe in anything, until the truth of your belief becomes a matter of life or death. It’s easy to argue that this rope is strong enough if you are going to tie it around a box. But, suppose, on the same rope you have to hang over an abyss. This is where you will understand how confident you are in the strength of your rope. So it is with relationships between people. For many years I believed that I completely trusted B.R. But then the time came when I had to decide whether to entrust him with an important secret.It was then that I realized the price of my “unlimited trust”. I realized that I never fully trusted him. The power of true faith is tested only by the test of risk. Probably, my faith (I thought I believed) allowed me to pray for people who were strangers to me and seemed to be true, because, by and large, I was indifferent to their fate.

But other difficulties arise here. Where is she now? Exactly where is she at the moment? If she left her body, and the body that I loved so much is undoubtedly no longer her, then she is nowhere to be found.After all, “present time” is a date or a specific point in time in which we live. As if she had gone somewhere without me, and I would have thought, glancing at my watch: “I wonder if she has already reached Euston?” But if it does not exist in the same time period with us, where one minute consists of 60 seconds, as for all living things, what does “now” mean? Where is the difference between “was”, “is” and “will be”?

My good acquaintances console me: “She is with God now.” This is true to some extent.She, like God, is inaccessible and defies any imagination.

But I suppose, as important as this question is in itself, it has nothing to do with the grief I am experiencing.

Suppose those several years of earthly life that we spent together were only the beginning, or a prelude, or an earthly manifestation of two unimaginable, supra-cosmic immortal creations. These “creations” can be imagined in the form of spheres or balls, and where the cosmic body of Nature flies through them, it cuts them into two halves, two hemispheres, which are in contact during their earthly existence.But this is what I yearn for, this is what I mourn, this is what I miss so much, the two halves of the circle, beyond their touch.

You say to me “It continues to exist”, but my soul, my body, my whole being cry out: “Come back, come back to me, be this circle, touch mine on the spaceship of Nature!” But I know it’s impossible. I want what I will never get. The good old life, jokes, arguments, a glass of wine, painfully familiar, everyday life. Whichever side you look at, “H.died “means” All this died with her. ” It has become part of the past. And the past is the past, this is the past tense, another name for death or heaven itself, where everything that was and died is located.

Talk to me about religious truth and I will listen with pleasure, Talk about your religious duty, I will obediently listen. But do not try to talk to me about the comfort of religion, otherwise I will think that you simply do not understand me.

Of course, if you literally believe in a meeting with family and friends in the afterlife, which people imagine in a completely earthly way, this changes the matter.However, this is not confirmed by any texts, everything is gleaned from bad hymns and cheap lithographs, the Bible does not say anything about this. And it sounds absolutely incredible. Reality never repeats itself. You cannot take something away and then return it in the same form. Spiritualists swallow the bait vividly: “everything there is exactly the same as here.” Cigars are also smoked in Paradise. This is what we would like. To restore past happiness.

This is what I want, and I cry about it at night, whispering passionate prayers into the void.

As poor S. quotes, “Do not mourn those who have no hope.” It amazes me how we apply words to ourselves to the best of us. What St. Paul says can comfort those who love God more than the dead and the dead more than themselves. When a mother mourns her child, she grieves not for the child she lost, but for the fact that her child lost, she finds consolation in the belief that her child has found a different life, it has not lost its purpose forever.But the consolation is also in her belief that having lost the most precious being, the meaning of her existence, she did not lose the most important thing; she hopes to “glorify God and find eternal joy in Him.” Consolation of the mother in the eternal divine spirit that will always be with her. But there is no consolation for her motherhood. The joys of motherhood were taken from her forever. She will never and nowhere hold her son on her knees, does not redeem him, does not read a fairy tale to him, does not dream about his future, never sees her grandchildren.

They say to me: “She is fine now,” they say to me, “She calmed down.”Where did they get such confidence? I don’t mean to say that I’m afraid of the worst. Almost her last words were: “I am at peace with God,” and she was not always at peace with Him. And she never lied. And it was difficult to deceive her, especially if this deception was in her favor .. I’m not saying that she lied. But where did they get that with death all suffering ends? Half of Christendom and millions of believers in the East are convinced of the opposite. How do they know she’s calmed down? Why should the separation, which is so terrible for the remaining one, not bring pain to the departed?

“Because she is now in the hands of God.”But for that matter, she had been in God’s hands before, and I saw what was done to her. What, we are suddenly treated more mercifully as soon as we leave our mortal body? If the goodness of God is inextricably linked with the infliction of pain, this means that either God is evil, or there is no God: for in the only life that is given to us, He causes such transcendental suffering that it is impossible even to imagine. If He makes us suffer so much during life, then He may well cause unbearable pain even after death.

Sometimes it immediately suggests itself: “God forgave God.” But if we truly believe, then He did not forgive, He crucified Him.

There is no need to deceive ourselves, we will gain nothing from this. We are doomed to suffer, and this is inevitable. Reality, if you look her straight in the eye, is unbearable. How and why did it blossom here and there and grow into a terrible phenomenon called awareness? Why did she bring to life us, who see this reality and shudder with horror? Who (not yet familiar with her) would want not only to see her, but also make every effort to find her, even if there is no need for this and even if just one glance at her leaves an unhealed ulcer in our hearts? Who? Such as H.who always wanted to know the truth at any cost.

If X is no longer there, then she was never there. I was mistaken in mistaking a cloud of atoms for a living person. Humans do not exist and never have existed. Death simply reveals the eternal emptiness that has always been. Those whom we consider alive have simply not been torn off the mask yet. All are bankrupt, but some have not yet filed for bankruptcy. However, this is complete nonsense: emptiness where no one has ever been? Who should declare bankruptcy? Other clusters of sparks or compounds of atoms? I will never believe, or more precisely, I cannot believe that one set of physical transformations can be replaced or mistaken for another.

No, it’s not materialism that scares me. If the materialists were right, we, or rather, what we take for “we”, could have avoided the torment, it’s as easy as shelling pears to swallow a handful of sleeping pills. I’m more afraid of something else – that we are rats in a mousetrap, or even worse, laboratory rats. Someone, I remember, said: “God always multiplies.” What if God does vivisection?

Sooner or later, trying to find the answer, I will be forced to face the truth and ask this question in simple human language.

What, besides our own desperate desire, justifies our faith in God’s mercy? All our experience confirms the opposite. What can we object to this?

We object – and Christ himself? But what if He was wrong too? His last words can have a simple explanation. He realized that God the Father was not at all what he should be. The trap, which had been carefully thought out in advance, prepared and skillfully placed the bait, finally worked – on the cross. The vicious prank was a success.

Why all my prayers get stuck in my throat and all hopes seem in vain – because I still remember very well how she and I prayed passionately and hoped in vain.We hoped not only because we wanted to hope, but also because we were given, even imposed, hope: erroneous diagnoses, X-rays, sudden improvements in the condition, which were perceived as a miracle. Step by step we were led along the “path of a blossoming garden,” and over and over again, when He seemed to be especially merciful, in fact, He already had another torture in readiness.

I wrote this down last night. It was not even a thought, but rather a cry. I will try again. Is it reasonable to believe that God is cruel? Can He really be so cruel? What, He’s a cosmic sadist, evil cretin?

If you think about it, this is pure anthropology, it is even more stupid than imagining Him as a kind king with a long beard.This image is a typical Jung model. This appearance brings God closer to the kind wise fairy kings, kind wizards, magicians and heroes of folk tales. Formally, we represent him as a human, but at the same time, a higher being is assumed, and at least we represent someone who is older than us, wiser than us, who knows much more than what is available to our imagination. The secret is kept. This leaves room for hope. Therefore, both for fear, and not just fears that they will play a cruel joke on you.Last night I imagined someone like S.S. – once he was my table neighbor and at dinner he liked to tell what he did with cats today. If He is the same as S.S. (even if this is a strong exaggeration), then, of course, he is not capable of creating anything, nor managing anything. He could only set up bait traps. But he would never have thought of such baits as love, laughter, daffodils or the sunset on a frosty day. And he created the universe? Such a creature is not capable of simply joking, or bowing, or apologizing, or making a friend.

Is it possible to seriously consider the idea of ​​an unkind God, as if from a “back door”, in the spirit of extreme Calvinism? You might argue that we are all mired in sin. We are so sinful that our ideas about good and evil are worthless, worse than that, what we consider good can turn out to be evil in its purest form. If our worst fears are confirmed, then God has all the qualities that are considered bad: recklessness, vanity, vindictiveness, injustice, cruelty. But what we see as black is actually white.Our own sinfulness turns everything black.

Well, so what? All our reasoning and assumptions destroy the very idea of ​​the existence of God. The very definition of “kind” becomes meaningless, like, say, “abracadabra”. There is no reason to obey Him, you shouldn’t even be afraid of Him. Yes, He threatens, He makes promises. But why believe them? If He considers cruelty to be mercy, then falsehood is also good. If so, what’s the difference? If His idea of ​​goodness is so different from what we think is good, then His paradise is, in our opinion, hell and vice versa.Finally, if reality itself fundamentally makes no sense to us, or in other words, we are complete idiots, what is the point of trying to think about God, or about anything at all? This knot is still untied, no matter how you try to tighten it.

How dare I even think about such muck and nonsense? Maybe I hope that if the feelings are so distorted then I will feel less? Aren’t my notes a senseless attempt by someone who doesn’t want to come to terms with the fact that the only way to end suffering is to accept and endure it? Who still hopes that there is some cure for pain if you just have to look hard? Whatever we do in the dentist’s chair, whether we grab the doctor’s hands or sit quietly with our hands folded on our knees, the drill continues to drill.

And grief still looks like fear, or rather, horror. Or waiting, as if you are sitting and waiting for something terrible to happen. All life takes on a permanent flavor of temporality. You don’t have to start anything. I can’t calm down, I’m yawning, I can’t find a place for myself, I smoke too much. Until now, I never had enough time, now there is nothing left in my life but time. Pure time, empty endless time

One flesh. Or, if you prefer, another comparison is a ship.The motor from the starboard side is lost, I – the remaining motor from the left side, must somehow spank to the dock. Rather, until the end of the voyage. How dare I even dream of a dock? Most likely, I will be greeted by a deserted shore, pierced by the wind, a black night, a deafening roar of the storm, piles appeared ahead, and a light flashing on the shore is most likely a drunken bum waving a lantern. This is what her approach to the shore looks like. My mother had the same. I call it their approach to the beach, not their arrival.

3

Actually, I don’t think about her all the time. For example, during work or conversation, this is simply not possible. But these periods when I don’t think about her are perhaps the worst of all. Because without even realizing the reasons, I feel that I am not myself, I am missing something. There are dreams in which nothing terrible seems to happen, nothing significant that could be told about at breakfast, but at the same time, the whole atmosphere of the dream, the special taste of nightmare, leaves the impression of horror.Also here. I notice that the rowan berries are starting to turn red, and for a second I can’t figure out why exactly the rowan plunges me into depression. I hear the chime of a clock, and something is missing in it, something is not that sound. What happened to the world, why does everything look so flat, colorless, worn out? And then I remember.

Here’s another thing that scares me. Nature will take its toll, the excruciating pain will gradually subside, nightmares will pass, but then what? Just apathy, dead boredom? Will there ever be a time when I will stop asking why the whole world has turned into a miserable street for me, because dirt and abomination of desolation have become the norm for me? Is sorrow followed by boredom with a touch of mild nausea?

Feelings, feelings and feelings.I’ll start thinking. If you think soberly, what new did X’s death introduce into my perception of the world? What is the basis for doubting what I have always believed in? I know perfectly well that every day all over the world people die, and even worse things happen. I must say that I took this into account, they warned me, and I warned myself – do not count on universal happiness. Moreover, suffering is foreseen, it is part of the plan. We were told, “Blessed are those who grieve,” and I agreed with that.I have not received anything that I did not expect. Of course, it makes a big difference when it happened to you and not to others, and not in imagination, but in reality. Yes, but how can a sane person understand this difference? Especially if his faith was true and his sympathy for the sorrows of others was sincere? The explanation is enough, even too simple. If my house collapsed from one breeze, then it was a house of cards. The faith that “took everything into consideration” was imaginary. Consider does not mean empathize.If I was really worried about other people’s sorrows, as I thought, I would not be so crushed by my own grief. It was an imaginary faith, playing with harmless counters, on which are pasted pieces of paper with the words: “sickness”, “pain”, “death” and “loneliness.” I believed that my rope was strong enough until it was so important, but when the question arose whether it would support my weight, it turned out that I had never believed in its strength.

Bridge fans say that you must play for money, otherwise you lose interest.It’s the same here. If you don’t put anything on the line, then it doesn’t matter whether there is God, there is no God, He is merciful, or an evil cosmic sadist, whether there is eternal life or not. And you will never realize how important this is to you until you start playing not for chips or sixpences, but put everything you have on the line, down to the last penny. Only this can shake someone like me and make them reconsider their views, start thinking and believing in a new way. This requires a good cuff to bring you to your senses.Sometimes the truth can only be achieved through torture, and only through torture you yourself will learn the truth.

I must admit (X herself would have achieved this recognition in no time) that if my house is built of maps, the sooner it is destroyed, the better. And only suffering can destroy it. And then all speculations about the Cosmic Sadist and the Eternal Vivisector become a meaningless and worthless hypothesis.

Does my last entry say that I am incurable, even when reality breaks my dream into small pieces, I still continue to mope, confuse everything even more, until the first shock has passed, and only then stupidly and patiently start to glue fragments.Will it always be that way? every time my house falls apart, should I rebuild it? Is this what I am doing now?

Of course, it is possible that as soon as what I call “the restoration of faith” happens, it will turn out to be another house of cards. I will not recognize this until the next click, say, when I myself fall ill with an incurable disease, or a war breaks out, or I ruin myself by making some terrible mistake at work. But two questions arise: in what sense can this be called a house of cards, because what I believe in is just a dream, or am I just dreaming that I believe?

If you face the truth, on what basis can you trust more what I thought a week ago than what I think now? I’m pretty sure that, in general, I am more normal now than I was in the first weeks.How can you trust the desperate imagination of a person who is in a semi-conscious state, like after a concussion?

Is it just because there was no attempt to wishful thinking? Because my thoughts were so terrible that that is why they most likely come closest to the truth? After all, not only pleasant, but also terrible dreams can come true. Were they so disgusting? No, I even liked them in my own way. I am aware that I am slightly resisting the nicer option.All my discussions about the Cosmic Sadist were most likely not a reflection of thoughts, but an expression of hatred. I took vengeful pleasure from them, the only pleasure available to a tormented person, the pleasure of giving back. Just an insulting curse – laid out to God honestly everything that I think about Him. And of course, as always, insulting someone in strong terms, you add: “I actually did not believe what I was saying.” I just wanted to offend Him and His followers.Saying like this always gives some pleasure. Expressed everything that boiled. After that you feel better for a while.

But the mood is not yet proof. Of course, the cat will screech and scratch, trying to escape from the hands of the veterinarian, and if it succeeds, it will bite. The question is who he is: a healer or a vivisector. The cat’s behavior does not shed light on this question.

I can believe that He is a healer if I think about my own suffering.It’s harder when I think about how she suffered. The agony of grief does not compare to physical pain. Only fools claim that moral suffering is a hundred times more terrible than physical. The mind always has the ability to regenerate. The worst thing that can happen, heavy thoughts come back again and again, but the physical pain can be absolutely endless. Grief is a bomb carrier flying in circles and dropping another bomb, making another circle and returning to the target. Physical suffering is like a constant barrage of fire in the trenches of the First World War, shelling that lasts for hours, without respite.Thoughts are not static, while pain is often static.

What is my love if I think more about my own, and not her suffering? Even my crazy pleas “Come back, come back!” – first of all, what I want for myself. I never wondered if this was possible, would it be good for her? I want her back to restore my past. For her, I could not wish anything worse: to experience death and return to earth to go through dying again, albeit later? Stephen is considered the first martyr, maybe the torment of Lazarus was worse?

I am beginning to understand.In strength, my love for her was about the same as my faith in God. However, I will not exaggerate. How much my faith was imaginary, and my love selfish, only God knows. I do not know. Maybe too strong, especially when it comes to my love. But neither one nor the other was, as I assumed, true, and both were quite a lot of the castle of cards.

What difference does it make how I grieve and what do I do with my grief? What difference does it make how I remember it, or do I remember it at all? Nothing will ease her past suffering.Past suffering. How do I know that all her suffering is in the past?

I never believed, considering it absolutely incredible, that the most devoted to God soul immediately, as soon as the last wheeze escapes from the throat of the dying man, finds peace and quiet. Believing it now is wishful thinking. H. was a bright personality, straightforward, bright soul, like a sword made of hardened steel. But she was not a saint. A sinful woman married to a sinful man. Two patients of God who still need to be healed.I know that it is necessary not only to dry the tears, but also to clean the stains so that the sword shines even brighter.

But please, oh God, be careful, be careful. Month after month, week after week, You stretched her poor body on a rack while she was still in it. Isn’t it enough?

The worst thing is that the perfect merciful God in this case is no better than the Cosmic Sadist. The more we believe that God hurts just to heal, the less we hope that he will hear our passionate pleas to be “careful.”

The cruel can be cajoled with a bribe, or he himself, at last, gets tired of his tiresome occupation, or he can find an unexpected attack of mercy on him, as an alcoholic suddenly has a period of sobriety. But suppose you are dealing with a skilled surgeon with the best intentions. The more conscientious and kind he is, the more ruthlessly he will cut. If he pauses in response to your pleas, or stops the operation altogether without completing, then all the suffering that you have experienced up to this point will be in vain.But is this outrageous torture really necessary? Well, decide for yourself, your choice. Torment is inevitable. If they are meaningless, then there is no God, and if He is, then He is evil. But if God exists and he is just, then torture is necessary. Because no even the slightest decent creature would allow unnecessary suffering.

In any case, we are doomed to suffer

What do those who say, “I am not afraid of God because I know that He is merciful” mean? Have they ever been to the dentist?

There, no less, the suffering is unbearable.And you babble: “If I could accept these torments, even the most terrible ones, instead of her.” But no one knows how serious such a high stake is, because in reality you are not risking anything. And if such an opportunity suddenly presented itself, we would discover how seriously we were ready for such a sacrifice. And are we allowed such a choice?

Only One was allowed, we were told, and again I begin to believe that He did his best to atone for sins. He replies to our babble: “You cannot and dare not.I could and I dared. ”

Something unexpected happened this morning. For many reasons, which in themselves are by no means mysterious, I felt a certain lightness in my heart, which I had not felt for many weeks. Firstly, I think I am starting to recover physically after tremendous stress and fatigue. I had worked 12 hours the day before and was not very tired; I slept well at night; and after two weeks of a low gray sky and a still damp stuffiness, suddenly the sun peeped out and shone, a fresh breeze blew, and suddenly, at the very moment when I missed her for the first time less, I remembered her especially well.And it really was something, almost better than a memory; some kind of sudden and inexplicable vision. To say that I saw her would be too much, nevertheless these words suggest themselves. As if someone lifted the veil of grief, and the barrier that separated us disappeared.

Why didn’t anyone tell me about all this? How easily would I judge another in the same situation? I could say, “He recovered from his loss. He began to forget his wife, “and the truth is this:” He remembers her better because he partially recovered. “And this is a fact. I think I can explain why this makes sense. You cannot see clearly if your eyes are clouded with tears. And you will never get exactly what you want, if you want too much, and even if you do, you will not be able to properly dispose of what you received.

“We need to have a serious talk” – this kind of introduction makes everyone fall into silence. “Today I absolutely must have a good night’s sleep” – and you will most likely spend a sleepless night. The best drinks are ineptly translated when they experience a particularly excruciating thirst.Doesn’t the same thing happen when we think about our dead, and it is because of our despair that the iron curtain falls, and it seems to us that we are gazing into emptiness? Those who ask (especially those who ask very much) will receive nothing. And perhaps they won’t.

And so, probably, with God. Gradually I began to feel that the door was ajar, there was no more lock and bolt. Was my desperate need to blame for the door being slammed in my face? Maybe just when your soul is screaming for help, God cannot give it to you? Just as it is difficult to help a drowning man if he flounders and grabs at everything.Maybe you are deafened by your own screams and therefore do not hear the voice you yearn to hear?

On the other hand, “knock and let it open.” But “knocking” does not mean banging and kicking doors like crazy. And again: “It will be rewarded to the one who has.” First of all, you need to have the ability to receive. If you do not have this skill, then no one, not even the most powerful being, can give you anything. It may be the passion of your desire that temporarily destroys your ability to receive.

Any mistakes are possible when you deal with Him. A very long time ago, when we were not yet married, one morning, when she was getting ready for work, she was suddenly seized by an inexplicable feeling that He was here, next to her, literally behind her shoulder, as if demanding her attention. Of course, not being a saint, she thought, as usual, that she was required to fulfill some duty, or to repent of something. Finally, she gave up – I know how we try to delay it – and came before Him. It turned out, on the contrary, that He wanted to repay her, and she was instantly filled with joy.

I think I am beginning to understand why grief is like expecting fear. Because the violation of a whole complex of very different impulses becomes habitual. Every thought, every feeling, every movement of my soul was associated with X. She was their target, she is no more. Out of habit, I take my bow, adjust the arrow, pull the string and suddenly remember … and put the bow back. So many roads can lead me to her. I stubbornly walk alone, one of many. But I stumbled upon a border barrier, I can’t go further.So many roads opened before me; now, wherever you turn – a continuous dead end.

For a good wife unites in one person all those you need on the path of life. Who was she not to me? She was my daughter and my mother, my student and my teacher, my servant and my master. And always, combining all these qualities, she was still my loyal comrade, friend, companion, fellow soldier. My beloved; and at the same time she gave me everything that no male friendship could give me (and I had many friends).Moreover, if we never fell in love with each other, we would still be always together and make a lot of noise. This is what I meant when I once praised her for her “manhood.” She immediately silenced me by asking how I would like it if she complimented my feminine qualities. That was a good retaliatory attack, my dear. But nevertheless, there was something in her from the Amazon, from Pentesilia and Camilla. And you, like me, were proud of it and were glad that I noticed and appreciated it.

Solomon called his wife Sister. Can a woman be considered a perfect wife if at least once, at a certain moment, in a certain mood, a man does not feel the need to call her Brother?

I am always tempted to say about our marriage: it was too good to last forever .. Although you can look at it in different ways. If you look pessimistically – as soon as God saw how happy His creatures were, He immediately decided to put an end to it. “Not allowed!”.So the hostess of the evening party, who invited you to sherry, immediately separates the two guests, as soon as they are carried away by a really interesting conversation. On the other hand, it can mean: “They have reached perfection. It became what it was supposed to be. Therefore, it makes no sense to continue further. ” As if God had said, “Well done! You have achieved mastery. I am very pleased with you. Now let’s move on to the next exercise. ” After you have learned how to solve quadratic equations, you even like to solve them, but the topic is passed, the teacher moves on to the next material.

Because we have learned something and achieved some goal. There is always a hidden or explicit struggle of the sexes between husband and wife, until the joint life erases all contradictions. Considering female fidelity, straightforwardness and courage as signs of masculinity is as arrogant as calling a man’s tenderness and sensitivity femininity. What a miserable and perverted part of humanity must be the majority of men and women who admit such arrogance! Marriage heals her.Uniting in marriage, the two merge into one full-fledged human being. “He created them in his own image and likeness.” Paradoxical as it may seem, the triumph of sexuality leads us to something that is much higher than sex.

And now one of them dies. And we think that love has been cut at the root; so the dance is interrupted in the middle of the pas, or only a blossoming flower is plucked, something interferes from the outside and disrupts the natural development of things. I do not know. If, as I stubbornly assume, the dead experience the pain of separation no less than the living (this may be one of the tests we undergo in purgatory), then for all lovers, without exception, grief is a universal and integral part of the experience of love.It follows marriage in the same way that marriage is a natural consequence of the courtship period, just as autumn follows summer. This is not the end of the process, but its next phase, not an interruption of the dance, but the next step. We give a part of ourselves to our beloved while she is alive. Then we begin to perform the following, the tragic step of our dance, when we must learn to give a part of ourselves, despite the fact that the corporeal shell of the partner has disappeared, learn to love the very essence of the deceased, and not our memory, or our own grief, or liberation from it, or our own love.

Now, when I go back in thought, I see that quite recently I was most concerned about memory and fears if it was deceiving me. It is not clear why (the only thing that comes to mind is God’s mercy), I stopped worrying about it. And what is interesting, as soon as this question ceased to interest me, I began to meet her at every step. “To meet” may be a bit too strong. I do not mean that I see her or hear her voice, nothing like that. I do not even mean a particularly strong emotional experience at any particular moment.Rather, it is a constant vague but deep feeling that she is always with me – a fact that needs to be taken into account. “Take into account” is perhaps a poor wording. Sounds like she was some kind of boyfriend. How can I put it more precisely? How about “serious reality”, “stubborn reality”? As if everything that I have experienced tells me: “It just so happened that you are terribly glad that she is. But remember, it is and will always be, whether you want it or not. Your desires are not taken into account. “

Well, what have I come to? Plus, any other widower who stops leaning on his spade and says, “Thank You, Lord. I shouldn’t complain. I miss her immensely. But it is said that tests have been sent down to us. ” We came to the same thing: a simple guy with his shovel and me, who is not a master of digging at all, neither a shovel, nor anything. And, of course, the fact that a test has been sent down to us must be correctly understood. God does not try to test how true or strong my faith or love is, He already knew that.I didn’t know that. He puts us at the same time in the dock, the witness’s seat and the judge’s chair. He knew from the very beginning that my temple is a house of cards. And the only way to make me understand this is to ruin it.

Getting over grief so quickly? But the words are ambiguous. Let’s say a patient has recovered from an operation for appendicitis. A completely different story, if his leg was amputated, after such an operation, either the stump will heal, or the patient will die. If the wound heals, the unbearable and endless pain will subside.The patient has grown stronger and waddles on his wooden leg. He recovered. But he will surely experience pain in the cult for the rest of his life, and at times quite severe. He will always be one-legged. Most likely, he will not forget about it for a minute. Everything will change for him: how he will wash, dress, sit down and get up, even lie in bed, he will be different. His whole life has changed. He was deprived of many pleasures and activities that he used to take for granted, even his duties have changed.I’m just learning to use crutches right now. Maybe in time they will give me a prosthesis. But I will never have two legs.

Still, I will not deny that in a sense I “feel better” and this feeling is associated with a sense of shame, as if I had to cherish and kindle my grief and remain unhappy. I’ve read about this once, but I never imagined it would happen to me. I am sure that X would not approve of this, she would say that it is stupid. And I’m pretty sure God doesn’t approve of it.What is behind this?

Partly, of course, vanity. We want to prove to ourselves that we are beloved in the highest sense, tragic heroes, and not ordinary rank and file in a huge army of those who have lost their loved ones, weaving with difficulty and just trying to survive. But this does not explain everything.

I think there is also confusion in thought. In fact, we do not want the continuation of these pangs of grief that we experience in the first weeks after the death of loved ones, no one wants this. We want our grief to be something of a recurring symptom, and we confuse the symptom with the disease itself.Last night I wrote down that grief after losing a spouse is not the end of love, but its next phase, like a honeymoon. We want to go through this phase while maintaining our love and loyalty. And if it hurts us (which is certainly true), we must accept this pain as an integral part of this phase. We don’t want to avoid pain, say, at the cost of a divorce. That would mean killing the dead one more time. We were one flesh. Now that half of it has been cut off, we will not pretend that we are still one.We are still husband and wife, we still love, and therefore we will continue to experience pain. But we, of course, if we understand ourselves well, do not want this pain for the sake of pain itself. The less it hurts, the better, the stronger the marriage bond. And the more joy remains between the dead and the one left to live, the better.

Better in every sense. Because, as I have found, the passion of our grief does not bring us closer to the dead, but, on the contrary, moves us away from them. This is becoming clearer and clearer to me.When I grieve the least – most often in the morning, taking a bath – it bursts into my thoughts, in all its reality and uniqueness. Not at all like in the worst moments, when my despair makes me see everything in one perspective and gives everything unnecessary pity, pompous solemnity, and when she appears herself, in all her truth. These are the best and most refreshing moments.

I remember, although now I cannot remember exactly how, that in various folk tales and ballads the dead do not want us to grieve for them, they beg us to stop mourning them.The meaning of this may go much deeper than I thought. If so, then our grandfathers were mistaken. All these (sometimes for the rest of their lives) mourning rituals – visiting graves, celebrating anniversaries, or when leaving the deceased’s room untouched so that “everything is as it was with him”, never mention his name, or mention, but in a special voice, or even prepare the deceased’s outfit (like Queen Victoria) every evening before dinner – it all smacks of mummification. This makes the dead even more dead. Maybe this was (albeit unconsciously) the goal? Something very primitive is at work here.Let the dead remain dead, it is important for the primitive mind of the savage to be sure that they have not imperceptibly made their way into the world of the living. Make them stay where they should be at any cost. Of course, all these rituals confirm death. And maybe just such a result is desirable, at least for those who perform these rituals.

But I have no right to judge them. These are all just guesses; I’d rather take care of myself. I have, no matter how you look at it, a simple program. I will, whenever possible, refer to her with joy.I will greet her with a laugh. The less I mourn for her, the closer I am to her. An admirable program. Unfortunately not feasible. Today the hellish torments of the first days have returned again; crazy words, a bitter feeling of resentment, an inner tremor somewhere in the stomach, the unreality of a nightmare., I am choked with tears. For grief never “stands still.” You just left the next phase, but you return to it, over and over again. All repeats. Do I dare to hope that I am not moving in a circle, but in a spiral?

And if in a spiral, then up or down?

How often (will it always be?) Will the feeling of emptiness overwhelm me, as if this is happening for the first time, and make me exclaim: “Never, up to this very moment, have I realized the full horror of my loss”? They cut off my same leg over and over again.Over and over, I feel the knife cut into my flesh.

They say that a coward dies many times, the same can be said about the death of a loved one. Did the eagle find a new liver each time from Prometheus, again and again tore it out and eat it?

4

This is the fourth and last clean notebook that was found in the house, almost clean, except for a few pages filled in by J.’s hand with ancient arithmetic exercises. I decided for myself, the notebook will end and I will stop my notes. I will not specifically buy new notebooks.Until now, these notes have served me as salvation from complete collapse, my last refuge, they helped me to some extent. On the other hand, it turns out that they are based on some kind of confusion .. I thought I could describe the state, draw a geographical map of my suffering. But it turned out that grief is not a state, but a process. It is not geography that is needed here, but history. And if I do not stop writing this story, putting an arbitrary point, then there is no reason to stop. After all, every day something new happens that needs to be entered into the diary.The mountain is like a long winding valley, where a new landscape opens up to you at every turn, but, as I said, this is not necessary, sometimes, on the contrary, a surprise of a different kind awaits you at the next turn: when you turn, you are amazed to find that you are in the same place that seemed to have passed a few hours ago. This is where you start to think, maybe this is not a valley at all, but a trench in the form of a vicious circle. No, this is not so, even if something is repeated, then in a different sequence.

Here, for example, another new phase, a new loss. I try to walk more, it’s stupid to even try to fall asleep if you don’t get tired. Today I decided to visit my favorite places where I wandered for hours during my idle years. This time, the face of nature did not look empty and devoid of beauty, the world no longer seemed like a squalid street (as I complained just a few days ago). On the contrary, every newly discovered species, every bush or group of trees filled me with the same happiness that I experienced before meeting X.But this invitation to happiness struck me as terrible. The happiness that was offered to me had no taste. I realized that I do not want such happiness. The very possibility of going back in time scares me. Such a fate – the most terrible of all possible – to reach a state where love and marriage in retrospect turns out to be just a sweet episode – like a holiday that briefly broke the usual, monotonous life, which ended, and I again what I was, unchanged, ordinary. And over time, the past holiday seems distant and unreal, so foreign in the very fabric of my history that it seems that all this was not with me, but with someone else.This would mean that she died for me a second time, and this loss would be even worse than the first. Anything but this.

Do you know, beloved, what you took with you when you left me? You took my past with you, even the past that I had before meeting you. I was wrong to think that my stump is healing after amputation. I was deceived because there are so many types of pain that time after time it catches me by surprise.

But I made two important discoveries for myself – I really know myself too well to believe that the benefits from them will be “lasting”.My mind, having turned to God, no longer rests against a closed door; turning to H., he does not meet the absolute, as before, emptiness, I am no longer concerned with how to mentally evoke her image. My notes do not reflect the entire process, as I hoped, but only a few moments. Maybe these changes are difficult to grasp. It was not a sudden insight and a complete emotional restructuring. So, for example, a cold room heats up, or brightens in the morning, when you first notice that it has become noticeably warmer or lighter, it turns out that it was getting warmer and brighter gradually, before you noticed it.

I wrote about myself, and about H., and about God. It is in this order. Such an order and such proportions are just absolutely unacceptable. It never occurred to me to give them praise. And that would be very helpful to me. Praise is one of the manifestations of love, bringing some element of joy into it. And you need to praise in the following order: Him as a giver, and her as a gift. After all, in giving praise, we, to some extent, enjoy the subject of praise, no matter how far from us it may be. I must give praise more often.I lost the ability to experience the pleasure that X gave me. And I got so lost in my doubts that I deprived myself of the joy that (if His mercy is unlimited) I could sometimes receive from God. By giving praise, I can rejoice in it to some extent, and at the same time, to some extent rejoice in Him. It’s better than nothing.

But perhaps I am deprived of this gift. I once compared it to a sword. This is true to some extent. But in fact it is completely untrue and misleading.It requires balance. I had to add: “but at the same time it is like a blooming garden, like a labyrinth, a garden shrub, a wall in a wall, a country outside the country, the further you go into it, the more mystery, the more fragrant and fruitful life.”

And praising everything created by God, I must exclaim: “Praise be to you, Lord, for you created all this!”

And praising the garden, we praise the Gardener, praising the sword – the blacksmith who forged it. Praise to Life, which gives life, and Beauty, which gives beauty.

“She is in the hands of the Lord.” And when I compare it to a sword, this comparison is filled with new energy. Maybe the earthly life I shared with her was only part of the temptation. Perhaps He is already grasping the hilt of a new sword and swinging it in the air, causing lightning. “Real Jerusalem steel.”

There was one moment last night that cannot be described in words, you can only make some comparisons. Imagine a man in pitch darkness. He thinks he is in some basement or dungeon.And suddenly an incomprehensible sound was heard. He assumes that the sound comes from somewhere far away – either the sound of waves, or the rustling of trees in the wind, or maybe a kettle is boiling somewhere half a mile away. If he hears all this, therefore, he is not in the basement, but outside, he is free. Or this sound is somewhere nearby, it is someone stifled laughter. If so, it means that he is not alone, next to him in the darkness is a friend. In any case, this is a kind sound. After all, I’m not crazy to think that this experience proves anything.This is just an attempt to present some idea, which I have always admitted theoretically, the idea is that I, like any mortal, may misunderstand the situation in which I am.

Five senses; incurably abstract thinking; selective random memory; a whole set of prejudices and unsubstantiated assumptions, there are so many of them that I can only investigate a certain, very small part, and sometimes I do not even suspect their existence. What part of reality can such an imperfect apparatus be able to pass through itself?

I will try my best not to get into the jungle.More and more, I am overcome by two very different beliefs. One of them – the Eternal Veterinarian is much more cruel and ruthless than we can imagine in the worst imagination .. Second – “everything will be fine, everything will be fine, everything will be fine”

It doesn’t matter that I don’t have any successful photographs of X. It doesn’t matter – almost none – if her image in my memory is imperfect. Images, whether they are captured on paper or in our memory, are not important in and of themselves. They are only slightly similar to the original.Draw a parallel at a higher level. Tomorrow morning the priest will give me a little round, thin, cold and tasteless cookie. Is it good, or bad, that the mallow does not even approximately resemble what it reunites me with? I need Christ, not something that resembles him. I need X herself, not something like her. A really good photograph can, over time, become a trap, a horror, and a hindrance.

The images are probably useful, otherwise they would not be so popular.(It doesn’t matter if statues and paintings exist outside of our mind, or are figurative constructions within it). Personally, I think that their danger is more than obvious. Images of a saint become holy images, they themselves become shrines. My idea of ​​God is not an idea of ​​divinity. It must be questioned from time to time. He loosens it himself. He himself is a great iconoclast. Is constant doubt one of the hallmarks of His existence? An excellent example is incarnation, it leaves no stone unturned from the early ideas of the coming of the Messiah.Most people are offended by iconoclasm, blessed are those who do not offend. But the same happens when we make our own prayers. Reality itself is iconoclastic. Your earthly beloved, even during her lifetime, constantly triumphs over your idea of ​​her. This is exactly what you want; you want her, with her resistance, her mistakes, her flaws, her unpredictability. That’s right: the living, real her, and not her images or the memory of her, we continue to love after her death.

But “this” is not yet imaginative. In this respect, she and all the dead are like God. In this respect, continuing to love her to some extent is like loving Him. In either case, I must stretch out the hands of love – the eyes of love are not suitable here – towards reality, in spite of and through the unsteady phantasmagoria of all my thoughts, passions and imaginations. I should not stay with the phantasmoria itself and worship it instead of Him, or love it instead of X. Not my idea of ​​God, but God himself.Not my idea of ​​H., but hers. Yes, and also not the idea of ​​the neighbor, but of the neighbor himself. Are we not making the same mistake in relation to the living, even to the people who are next to us in the same room? Do we talk and behave as if we are not dealing with the person himself, but with his image – almost exact, created by our imagination? And the difference between a true person and a person we imagine becomes quite striking, before we finally admit it to ourselves. In real life (and not in novels), if you look closely, in his statements and behavior he comes out of “character”, from what we call his character.He always unexpectedly lays out a card that we never knew existed.

I believe that I misjudge others on the basis of the fact that they make the same mistake towards me. And we all think we’ve got each other through.

It may turn out that all this time, once again, I was folding the house of cards. If so, He will break it down again with one click. And he will do it every time he considers it necessary. Unless you are convinced that I am incorrigible, and I will not end up in hell, where I will forever build palaces of cards, “free among the dead.”

And what if I come gradually to God, then only in the hope that He will lead me to her? But at the same time, I perfectly understand that you cannot use God as a path to achieve your goal. He must be the end, not the means, He is the end of the path, not the path itself, otherwise you will never come close to Him. This is the main mistake of various popular pictures depicting happy reunions with relatives and friends “in the transcendent future”, the mistake is not in the simple and very earthly images themselves, but in the fact that what they call the end of the path is in fact only intermediate point on the way to the true end.

Oh, God, is it really only on these terms? Will I really be able to meet her, if only I love You in such a way that I don’t care if I meet her or not? Think, oh, Lord, this is how we see it. What would you think of me if I told the children: “No candy! Grow big and stop wanting them, then you can eat as many sweets as you like! ”

If I knew for sure that we were torn apart forever, and that she had forgotten about my existence forever – but this would bring her joy and comfort, I would, of course, say: “Please, I agree, go ahead!” Just as if in mortality I could cure her of cancer by agreeing never to see her again, at that very moment I would arrange everything possible to never see her again.I would have to agree, like any decent person. But, unfortunately, I have not been given this choice.

When I ask all these questions to God, I get no answer. But this is not the same “There will be no answer!” This is not a door slammed shut in front of your nose. Rather, it is a calm, clearly without any sympathy, look. As if He shook his head not as a sign of refusal, but as if not wanting to discuss the issue. As if to say: “Calm down, my child, you do not understand.” Can a mortal ask God questions that He does not consider necessary to answer? And very simple, I think.Pointless questions don’t require an answer. How many hours are there in one mile? Is yellow round or square? I am afraid that a good half of our great theological and metaphysical problems are like these questions.

And if you think about it, then I have no practical tasks at all. I know two great commandments and I will stick to them. With her death, one problem went away. While she was alive, she could practically be more important to me than God, I could do what she wanted, not God; if there was a question of choice.Now I am faced with a problem where there is nothing I can do about it. There was only a load of feelings, motives, and so on of the same kind. With this I have to figure it out myself. I don’t believe this is God’s problem.

Gift of God. Meeting with the dead. No matter how much I think, nothing comes to mind except the association with playing chips. Or blank checks. My idea, if you can call it an idea, is that tokens are a risky attempt at extrapolating from just a few very short terrestrial episodes.And I suspect that these episodes are not the most significant, maybe even less important than those that I take into account. The idea of ​​a blank check is also an extrapolation. In reality, both (trying to win or getting cash on a check) are likely to shatter all the ideas about both chips and checks (moreover, the relationship of both ideas to each other).

Mystical reunion, on the one hand. Resurrection from the dead, on the other. I cannot reach even a hint of an image, or find a formula, or even just feel what unites them.They are united by reality (and we have been given this understanding). Reality is another iconoclast. Yes, heaven will solve all our problems, but I think, without demonstrating a skillful smoothing out of all our obviously contradictory ideas, they will immediately knock the ground out from under our feet with our ideas. We will see that there was no problem either.

And again, more than once, the same experience will arise, which I cannot describe in any way other than to compare it with muffled laughter in the dark. The guess is that the only correct answer is overwhelming and disarming simplicity.

We often think that the dead can see us. And we conclude from this, no matter if there is any reason for it, that if this is true, then they see us more clearly than in life. Does X now see how much foam and tinsel was in what we both called “my love”? May it be so. Look with all your might, dear. I won’t hide anything from you, even if I could. We did not idealize each other. We had no secrets from each other. You knew all my weaknesses. And if now, from there, you see something worse, I can accept it.And you can too. Scold, explain, tease, forgive. Because one of the miracles of love is that she gives both, especially a woman, the ability to see a partner through and through, despite being bewitched by love, at the same time not being freed from her spell.

To some extent, this is the ability to see everything like God. His love and His knowledge are inseparable and inseparable from Himself. We can always say: He sees because He loves, and He loves because He sees.

Sometimes, oh Lord, we tend to ask You, if You wanted to see us as pure as lilies, then why did You not create a world like a lily meadow? I suppose because You set up a great experiment.Although no, you don’t need experiments, you already know everything. Rather, it was a great undertaking: to create an organism, but at the same time a spirit, to create a terrible oxymoron, a “spirit animal.” Take a poor primitive creature, a creature with bare nerve endings, with a stomach constantly demanding food, an animal that needs a female to reproduce, and order: “Now live yourself. And become a god. ”

In one of my previous notebooks, I wrote that if I were suddenly presented with something even remotely similar to proof of the existence of H.I wouldn’t believe it anyway. Easier said than done. Even now, after what I experienced last night, I am not going to take this as evidence of a connection with her. But the very “quality” of the experience, although it proves nothing, is worth trying to describe. It was completely devoid of any emotion. It was as if her mind had collided with mine for a moment. It is the mind, not the “soul,” what we usually consider the soul. The absolute wrong side of what we call “soul fusion”.Not at all the notorious meeting of two lovers, rather, it looks like a phone call or a telegram from her, with some kind of news or order. No specific message – just mind and attention. There was no sense of joy or sadness, no love in the usual sense, no lack of love. Until now, I have never imagined that the dead can be so, or something, business. And at the same time, I felt an extraordinary feeling of endless and joyful closeness. An intimacy that has nothing to do with feelings or emotions.

If these were the echoes of my unconscious state, then my “unconsciousness” turns out to be much more interesting in its depth than psychologists imagine. First of all, it is much less primitive than my consciousness.

No matter what it was, my mind brightened like a house after a general cleaning. This is how the dead should be – pure reason. Any Greek philosopher would not be surprised at what I experienced. He would not have expected anything else: if anything remains after our death, then it is this – the mind.Until now, this idea has thrown me in a creep. Lack of emotion turned me off. But with my contact (I don’t know, real or imagined), I did not feel any disgust, as I realized that emotions are no longer needed here. It was complete, endless intimacy, all-encompassing and healing, but devoid of feelings. Maybe this closeness is love itself, which in life is always accompanied by emotions, not because love in itself is a feeling, or because it is always accompanied by emotions, but because our living soul, our nervous system, our imagination inevitably must to react to love in your own way? If so, how many more prejudices I should sweep aside! A society or a commune where pure reason reigns cannot be cold, gray and insensitive.On the other hand, it should not be something to which people attach such definitions as “spiritual” or “mystical” or “saint”. If I could just look, take one look, then I would use (I am a little afraid to use them) other definitions. Bright? Glad? Brave? Attentive? Spicy? Vigilant? First of all, one-piece. Completely reliable. No nonsense when it comes to the dead.

And when I say intellect, I also mean will. Attention is an act of will.Reason in action is basically will. And for me this is the complete resolution of all issues.

Shortly before the end, I asked her, “Could you come to me – if permitted – when is my turn to die?” “Permitted!” She said, “If I find myself in heaven, it will be difficult to keep me, and if in hell, I will blow everything to pieces there.” She understood that we were speaking in a conventional mythological language with some element of comedy. And she even winked at me through her tears. But there was no myth and not a shadow of a joke in the will that pervaded her entire being, in the will that is deeper than any feeling.

However, although I am less confused about what pure reason is, I should not go too far. We should not forget about the resurrection from the dead, although we do not understand what that means. We cannot comprehend this, which is probably for the best.

Mankind has once pondered over the question of whether the last vision of God is an act of love or reason. However, this is most likely another pointless question.

Isn’t it a sin to call upon the dead to return, if this were possible! She said not to me, but to the confessor, – “I am at peace with God.”She smiled, but not at me. Poi si torno all ” eterna fontana. She fell to the eternal source.

90,000 A person can feel someone else’s pain

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Research has shown that people can actually feel what others are experiencing.

“I know how you feel” – this phrase is really true.The researchers concluded that the human brain is designed in such a way that it can actually feel what the other is feeling.

There are people who know how to put themselves in the place of another. But now it turns out that the pain they feel when they see suffering is real.

Synesthesia is key here. These are phenomena when separate emotions are mixed.

An example of synesthesia is the following: a person associates the sound of a word with a certain color or feels its “taste”.

As for the sensation of someone else’s pain, here we are talking about a more rare phenomenon – mirror synesthesia. This condition is associated with the response of mirror neurons. They were first discovered in the 1990s, when a group of Italian scientists studied the features of brain activity in monkeys. Zoologists have stumbled upon special cells in the cerebral cortex. Neurons were activated not only when the macaque itself performed an action, but also when it watched how the same action is performed by a person.Hence the name – mirror neurons.

New research in this area may finally shed light on the phenomenon of “empathy” in humans.

In the case of mirror synesthesia, a person feels a touch when someone else is touched in front of their eyes.

This phenomenon was first discovered by Dr. Sarah-Jane Blackmore of University College London in 2003.

“I was giving a lecture and I mentioned synesthesia. I also laughed at reports that some people supposedly feel touched when no one really touches them, Blackmore recalls.- Then one of the listeners asked: “Is there anyone who does not feel it? Is this not normal? ”

Until then, the 39-year-old woman did not realize that she had a phenomenon of mirror synesthesia. When she saw someone touching her left cheek, she felt this touch on her, but on her right. If she was not standing in front of the person, but behind him or next to him, a touch on his right side was also given to her right.

At the moment, British scientists have identified several more cases of mirror synesthesia.

“I never understood how you can watch bloody horror movies or laugh at the painful sensations of comedy characters, while I not only see what is happening on the screen, but also feel the same as they do,” says student Ellis. which revealed this condition.

Another student named Jane thinks synesthesia is a good thing because it “helps you better understand other people.”

This condition is more or less common to all people, the peculiarity and uniqueness of mirror synesthesia lies in the fact that mirror neurons in humans are overactive.

“It is unusual to think that some people feel a touch when they push and hit another. However, this is just a high degree of compassion, inherent in each and every one ”, – comments specialist Jamie Ward.

The results of studies on mirror synesthesia will also help shed light on the causes of diseases such as schizophrenia or autism.

“Autism is known as a condition where a person is unable to understand the emotions of others,” continues Blackmore.