Angina

Angina is chest pain that is caused by a lack of proper blood supply to the heart. It is almost always due to atherosclerosis, partial occlusions of arteries that supply the blood to the heart (plaques). Plaques are deposits of fats, cellular debris (garbage) and irregular growth of normal cells of the artery. The heart muscle doesn’t get the blood needed for efficient muscle contraction, and the heart muscle itself becomes ischemic (lacking in blood and oxygen). The heart has to pump increasingly harder with a smaller supply of blood to its own muscle. The lack of blood flow causes a build up of metabolites which is thought to cause the pain.

Symptoms

Angina is not always perceived as pain, but may feel like an ache, squeezing or crushing sensation or pressure, or heaviness. It is frequently felt in the middle of the chest, but can be felt anywhere in the thorax region and upper abdomen. It also may be felt with radiation into the shoulder and neck, and even though the heart is located on the left side, pain may be felt in the right arm as well.

Angina most often comes in intermittent attacks and usually last no more than a few minutes. It is worse with exertion and better with rest. There are several different types of angina characterized by the timing and duration of symptoms. Stable angina the most common form and is better with rest. Unstable angina is chest pain that is not better with rest, happens at rest or is longer in duration. Unstable anginal pain is considered to be more severe than stable angina, and less responsive to treatment. Unstable angina is considered to be a medical emergency situation and should be cared for in a specialized cardiac care unit.

Angina with pain at night is known as nocturnal angina. Pain that occurs spontaneously at rest but with complications is known as decubitus angina. Prizmetal’s angina or variant angina is chest pain from a vascular spasm.

Diagnosis and Pharmaceutical Interventions

Often the diagnosis of Angina is made from the symptoms alone. Changes in the electrocardiogram (ECG), showing the heart’s electrical activity may confirm the diagnosis. A normal ECG in a person at rest does not rule out angina, but an ‘exercise’ ECG, taken with the person on a treadmill, is a surer way to diagnose the condition. This can also be achieved by performing a stress echo for those with mobility problems.

By doing the Cardiac Risk Assessment you can quickly see whether you are at risk of heart disease. Routine tests such as measuring pulse, blood pressure, testing for diabetes and blood cholesterol levels, and checking whether there is a family history of CHD, and an assessment of symptoms may also provide supporting evidence for the diagnosis.

An angiogram (or ‘cardiac catheter’) may help confirm the diagnosis. This is a procedure involving passing a fine hollow tube called a catheter to the coronary arteries under x-ray guidance. An x-ray contrast material is then injected and several x-rays are taken to identify the position of any narrowing of the artery.

Pharmaceutical interventions

Nitro-glycerine

Nitro-glycerin products are taken orally as a tablet or sublingually under the tongue as a spray or tablet, or as a patch. Nitrates work by relaxing smooth muscle causing the coronary arteries to dilate, therefore increasing the amount of blood flow. This reduces the heart rate and blood pressure and stabilises heart rhythm.

Lifestyle and Dietary Modifications

Any positive change that is recommended to reduce your risk of heart disease will reduce your risk of angina. As with most conditions, diet is the first and best place to start treatment. Dietary changes have been studied extensively, especially a low- fat, high fibre diet. These diets are low in saturated fat and low in trans-fatty acids (partially hydrogenated fats found in margarine and many processed foods containing vegetable oils), and higher in omega 3 fatty acids like those found in fish. It is also low in simple sugars/carbohydrate but high in complex carbohydrates and emphasizes lots of fruits and vegetables.

Regular physical exercise is important to reduce the risk of heart disease and stroke. By increasing blood flow and oxygen to the heart and tissues, it reduces blood pressure, reduces the chance of obesity and helps with a stressful lifestyle.

Quitting smoking is one thing you can do for your health that will help not only reduce your risk of heart disease but improve overall health. Smokers have lower levels of HDL, the good cholesterol. Smoking is the number one risk factor associated with several chronic diseases, including several forms of cancer, osteoporosis, and chronic obstructive pulmonary diseases.

One or two cups of coffee per day slightly increased exercise tolerance before angina, while five or more cups significantly increased risk of angina compared to those drinking none. Some case reports have linked reactive hypoglycemic episodes with angina symptoms.

Smoking makes angina more treatment resistant. Several studies show exercise is beneficial, but pursue with caution and oversight. Acupuncture and Transcendental Meditation also have some research support.

Nutritional Factors Shown to be Beneficial

Note: These treatments are recommended for stable angina. Unstable angina is an unpredictable condition, and not proven to respond to the treatments listed below.

CoQ10

CoQ10 is a substance involved in the production of energy. It works as an electron carrier in the mitochondria of cells. It is considered to be very close in action as Vitamin E, and can protect against several forms of heart disease.
Dose: 120 mg (or more) per day.

L- Carnitine

This non-essential amino acid (it can be made by the body) is used by the cells to release energy from fat. It transports fatty acids into mitochondria, the powerhouses of cells in the heart. It is useful for people with stable angina, as it may help with exercise ability.
Dose: 1 gram (or more) per day

Hawthorne (Crataegus oxycantha)

Hawthorne leaves, berries and flowers contain flavonoids known as oligoeric proanthocyanidins which have antioxidant activity. It also increases blood flow to the heart enhancing the hearts use of oxygen. Hawthorne is best used long term.
Dose: 250-500 mg a day, best used long term

Magnesium

Magnesium therapy is a must for any heart condition. Magnesium deficiency may be a contributing factor for spasms that occur in coronary arteries, particularly in variant angina.
Dose: 400-800 mg a day

Tocotrienols/Vitamin E

Vitamin E is a general term for a chemical class known as the tocopherols and tocotrienols. These compounds are antioxidant and can help reduce the oxidation process that occurs with atherosclerotic plaques, and they can increase the viscosity of the blood and improve blood flow. They seem to better in a combination of mixed tocopherols instead of alpha tocopherol, which most vitamin supplements consist of alone.
Dose is 400-800 IU a day

Arginine

Nitroglycerin and similar drugs cause dilation of arteries by interacting with nitric oxide, a potent stimulus for dilation. Nitric oxide is made from arginine, a common amino acid.
Dose: 1-3 grams a day

Fish oils

Fish oil, which contains the fatty acids known as EPA and DHA, has been studied in the treatment of angina. In some studies, enough fish oil to provide a total of about 3 grams of EPA and 2 grams of DHA has reduced chest pain as well as the need for nitroglycerin.
Dose: 5 grams total omega-3 a day

Terminalia ajuna

Also called ajuna, this plant is an Ayurvedic herb. It has been studied for the treatment of stable angina, with results showing a reduction in chest pain and blood pressure
Dose: 1-3 grams a day

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