What is Angina?

A general health article about Angina from
Your Health Online the A to Z directory of
dealing with Health Problems & Self Care Strategies

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina is a heavy, tight squeezing pain in the chest caused by insufficient oxygen supply to the heart (low blood flow to the heart). It generally occurs when the heart is working hard and requires more oxygen: during exercise, at times of stress, in extremes of temperature, soon after a meal. Typically the pain develops at the same point in daily activity: on stairs climbing to the office, at a certain point in the daily walk, etc.

Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease.

CAD occurs when a fatty material called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced. This causes pain and can lead to a heart attack.

Signs & Symptoms of Angina

You experience a pain in the centre of the chest, which may also travel into the neck, jaw, and arms (especially the left). Angina is usually described as a crushing or heavy or gripping pain. It mostly follows exercise, but may also be triggered by emotion, digesting a heavy meal, or going out in a cold wind. Sometimes you may also feel breathless.

The pain often radiates through the left shoulder, arm, or jaw and can last for up to 20 minutes. For some the pain might be intense, while others may feel only a mild discomfort--sometimes thinking they are only experiencing indigestion. Some individuals have no symptoms at all--"A Silent Heart Attack."

Other symptoms include sweating, nausea, vomiting, anxiety, shortness of breath, ringing in the ears, loss of speech, dizziness, fainting. Irregardless of the level of discomfort, any angina is a gravely dangerous situation because it is often the precursor sign of a full heart attack (complete cut off of blood to the heart).

When angina occurs it usually lasts only a few moments and goes away with rest. Sometimes it is worse when a person is active after having eaten. It is usually worse in cold weather or when moving from a warm room to a cold one. Sometimes experiencing a strong emotion while resting (or having a bad dream) can trigger it.

Typically, a person will feel pain or an ache or a sensation of pressure just beneath the breastbone. Many people describe the feel as discomfort or heaviness rather than pain. The ache or pressure might also be felt in either shoulder or down the inside of the arms, the back or in the throat, jaw or teeth

The symptoms of angina that are felt by older people or by women may be different and easily misdiagnosed. Pain may be felt in the stomach area, especially after a meal. It may resemble indigestion.

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.

Stable Angina Stable angina is the most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur.

The pain usually goes away in a few minutes after you rest or take your angina medicine.

Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.

Unstable Angina

Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine.

Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.

Variant (Prinzmetal's) Angina

Variant angina is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.

There is a form of angina called cardiac syndrome X. In this form, there is neither a spasm or any detectable block in the coronary arteries. In some people, the pain and pressure in the chest may be a result of a temporary narrowing of the smaller arteries of the heart. No one knows what causes this, but it may be the result of a chemical imbalance in the heart or abnormalities in the arteries.

The three types of angina are stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.

Stable Angina

Stable angina is the most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur.

The pain usually goes away in a few minutes after you rest or take your angina medicine.

Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.

Unstable Angina

Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine.

Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.

Variant (Prinzmetal's) Angina

Variant angina is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.

There is a form of angina called cardiac syndrome X. In this form, there is neither a spasm or any detectable block in the coronary arteries. In some people, the pain and pressure in the chest may be a result of a temporary narrowing of the smaller arteries of the heart. No one knows what causes this, but it may be the result of a chemical imbalance in the heart or abnormalities in the arteries.

What Causes Angina?

Angina is rather similar to cramp in a muscle during vigorous exercise. It is caused by the muscles of the heart not receiving enough oxygen (via the blood) for the work they are performing. This is because the blood vessels which supply the heart muscles with oxygen have become narrowed. The main cause of narrowing of the blood vessels is age, but this is accelerated by cigarette smoking. To a lesser extent people with a high cholesterol level, people who are obese (overweight), and diabetics are also more at risk.

Fatty deposits in the arteries that feed the heart or sometimes because of other abnormalities that interfere with the flow of blood to the heart muscle are the main causes. Not everyone with coronary artery disease has angina.

Angina can also be caused by severe anemia - a condition in which the body has fewer red blood cells or less hemoglobin, which carries oxygen. Rarer causes of angina are severe high blood pressure, a narrowing of the aortic valve (aortic valve stenosis), leakage from the aortic valve, thickening of the walls of the ventricles. All of these factors make the heart work heart and increase its need for oxygen. Abnormalities of the aortic valve may also reduce the blood flow through the arteries of the heart. The openings for these arteries are just beyond the aorta.

Risk Factors:

All of us have fatty deposits in our arteries to some degree. Atherosclerosis can start as early as our 20s and increases with age.

But there are risk factors that are known to increase the development of fatty deposits that can cause your arteries to narrow.

• A family history of atherosclerosis.

• High levels of LDL cholesterol in the blood.

• High blood pressure.

• Smoking.

• Being male.

• Diabetes.

• Obesity.

• Stress.

• Lack of regular exercise.

Prevention:

• Do not smoke.

• Lose weight if you are over weight.

• Eat a low fat diet with a good fibre intake. <

• Take regular exercise and if possible build this up slowly. If necessary your doctor may arrange some help with this.

• Avoid unnecessary stress and learn relaxation techniques.

• Do not drink more than 21 units of alcohol per week if you are a woman or 28 per week if you are a man. (1 unit = half a pint of standard beer or one glass of wine.)

• Do not add salt to your food.

When to seek Medical Advice:

Diagnosis of angina is largely from the history. That is, there has been pain, usually brought on by exertion, which is situated as indicated above, usually goes off within a few minutes when you stop what you are doing, and is relieved by sucking a GTN (glyceryl trinitrate) tablet under the tongue.

Your doctor may also want you to undertake an electrocardiogram (ECG - a tracing which shows the electrical activity of the heart) and an exercise ECG (this involves walking on a treadmill while attached to an ECG). He is also likely to check your weight, blood pressure, various blood tests including blood sugar and cholesterol, and to discuss your smoking and drinking habits. All of these may be normal even though you are suffering from angina.

Diagnonis:

Physicians can usually diagnose angina based on the patient's symptoms and the precipitating factors. However, other diagnostic testing is often required to confirm or rule out angina, or to determine the severity of the underlying heart disease.

Electrocardiogram (ECG)

An electrocardiogram is a test that records electrical impulses from the heart. The resulting graph of electrical activity can show if the heart muscle isn't functioning properly as a result of a lack of oxygen. Electrocardiograms are also useful in investigating other possible abnormal features of the heart, such as arrhythmia (irregular heartbeat).

Stress test

For many individuals with angina, the results of an electrocardiogram while at rest will not show any abnormalities. Because the symptoms of angina occur during stress, the heart's function may need to be evaluated under the physical stress of exercise.

The stress test records information from the electrocardiogram before, during, and after exercise in search of stress-related abnormalities. Blood Pressure is also measured during the stress test and symptoms are noted.

In some cases a more involved and complex stress test (for example, thallium scanning) is used to picture the blood flow in the heart muscle during the most intense exercise and after rest.

Angiogram

The angiogram, which is a series of x rays of the coronary artery, has been noted as the most accurate diagnostic test to indicate the presence and extent of coronary disease. In this procedure, a long, thin, flexible tube (catheter) is inserted into an artery located in the forearm or groin.

This catheter is passed further through the artery into one of the two major coronary arteries. A dye is injected through the catheter to make the heart, arteries, and blood flow clearer on the x ray.

A fluoroscopic film, or series of "moving" x rays, shows the blood flowing through the coronary arteries. This will reveal any possible narrowing that can cause a decrease in blood flow to the heart muscle and associated symptoms of angina.

Treatment/Therapy:

If you think you have angina you should consult your doctor. He may well prescribe some tablets to suck under your tongue (these are however cheaper to buy over the counter), or the same medication as a spray (this has a longer shelf life than the tablets which only last two months after opening).

They work by opening the blood vessels, and as a result may give a side effect of throbbing headache. If this happens you can spit out the tablet as it will already be working on the blood vessels. Should you suffer from this side effect, persevere as it usually wears off after the first two or three tablets.

Angina usually lasts no longer than ten minutes, and if you get it you should stop what you are doing and take one of the tablets or a puff of the spray under your tongue. If an activity always seems to bring it on then it is wise to take the treatment before you start. If you are suffering frequently you should consult your doctor as he will probably wish to consider preventative treatment which will involve regular tablets.

If your symptoms are not controlled by drugs and also if the tests suggest it, your doctor may refer you to a heart specialist (cardiologist) for consideration of further treatment. It is likely that at this stage you would have a test to show up the blood vessels which supply oxygen to the heart muscle (coronary angiography).

Further treatment is not necessary except in quite advanced cases and involves either using a tube to enlarge the blood vessels where they are narrowed (angioplasty) or bypassing the blood vessels with alternative vessels (coronary artery bypass grafts - CABG).

Self Care strategies for Living with Angina

• Make sure your diet is well balanced and contains plenty of fiber. Eat plenty of raw foods. For protein, eat broiled fish and skinless turkey and chicken, which are low in fat.

• Include in the diet garlic, onions, and lecithin. They effectively reduce serum cholesterol levels.

• Add raw nuts (except peanuts), olive oil, pink salmon, trout, tuna, Atlantic herring, and mackerel to your diet. These foods contain essential fatty acids.

• Do not consume stimulants, such as coffee and black tea, that contain caffeine. Also avoid tobacco, alcohol, chocolate, sugar, butter, red meat, fats (particularly animal fats and hydrogenated oils), fried foods, processed and refined foods, soft drinks, spicy foods, and white flour products, such as white bread.

• Drink steam-distilled water only.

• If you take an anticoagulant (blood thinner) such as warfarin (Coumadin) or heparin, or even aspirin, do not take supplemental vitamin K.

• Eat more of the following: wheat germ, vitamin E, soybeans, and sunflower seeds.

• According to some studies, magnesium supplementation can correct some types or irregular heartbeat, and could save the lives of many people with heart trouble.

• Citrin, an extract from the plant Garcinia cambogia, inhibits the synthesis of fatty acids in the liver, thus helping to prevent the accumulation of potentially dangerous fats in the body.

• Other herbs beneficial for cardiovascular disorders include barberry, black cohash, butcher's broom, cayenne (cpsicum), dandelion, ginseng, hawthorn berries, and valerian root.

• Avoid the herbs ephedra (ma huang) and licorice; they can cause a rise in blood pressure.

Lifestyle Changes

• Keep your weight down. Obesity is a risk factor for heart attacks and high blood pressure. Get regular moderate exercise. Caution: If you are over 35 and/or have been sedentary for some time, consult with your health care provider before beginning an exercise program.

• A walking, swimming, or other aerobic exercise started gradually and consistently used will greatly improve the physical conditioning of the heart.

• Stop smoking and drinking alcohol and coffee because these substances have been proven to increase your risk of heart disease. If you insist on continuing to compromise your body with these substances, you should also take extra antioxidants to help the body fight of the damaging effects.

• Avoid fried foods, and try to limit simple carbohydrates (sugar, honey, dried fruit, fruit juices, refined white flour).

• Avoid stress, and learn stress-management techniques such as progressive relaxation, meditation, or guided imagery.

• If you experience any of the symptoms of a heart attack, contact your doctor or go immediately to the emergency room of the nearest hospital, even if symptoms last only a few minutes. Half of all heart attack deaths occur within three to fours hours of the onset of the attack, so a person suffering from a heart attack requires immediate medical attention.

Medical Options and Precautions

• Coronary artery bypass surgery and angioplasty usually cost about $40,000 to $100,000. Before proceeding with surgery learn exactly what and how much of your body will be affected by the surgery. For example, the general process in bypass surgery is to make an incision opening from the top of the sternum to the navel, break the sternum, roll back the ribs, attach the heart to a machine, cut open the leg from the hip to the ankle to acquire an alternate blood vessel, use that blood vessel to bypass the problematic area, and then put everything back in place and hope that it all functions adequately.

Obviously this invasive procedure is quite traumatic on the body and would require many weeks of recovery. Also, the surgery has not cured the mechanisms of damage. If the lifestyle mechanisms that caused the damage are not changed another surgery will probably have to be done in the not too distant future.

• Also, surgery opens up direct exposure to death. In the ongoing sophisticated study of bypass surgery, the Coronary Artery Surgery Study (CASS), it was demonstrated that heart patients with healthy hearts but that had one, two, or all three of the major heart vessels blocked, did surprisingly well without surgery. Regardless of the severity of the blockages each group in the study had a death rate of 1 percent per year.

That same year the average death rate from bypass surgery was 10.1 percent. That's one death in every 10 surgeries. In other words, the operation being recommended to save a life costs thousands of dollars and was ten times more deadly than the disease itself!

• Try to talk with someone who has had the surgery done and find out their feelings on the procedure.

• Most importantly, obtain a second and even a third professional opinion as to why the surgery is needed and what other noninvasive options might be possible instead of surgery.

• EDTA Chelation Therapy is an alternative treatment for angina, peripheral vascular disease, and cerebral vascular disease. The relative cost is less than $2,500. Persons interested in more information on this type of injection therapy can contact the American College for the Advancement in Medicine (ACAM), 23121 Verdugo Drive, Suite 204, Laguna Hills, CA 92653. Outside California 1-800-532-3688. Inside California 1-800-435-6199.

• Learn all about the drugs that have been prescribed for you. Know what to do in case of an emergency. Keep emergency and ambulance numbers easily accessible. If you have a heart condition, someone close to you should know what to do if cardiac arrest occurs. Make sure your loved one knows how to do cardiac massage and mouth-to-mouth breathing. The American Red Cross and many local hospitals offer training in these techniques.

• The use of a test called cardiokymography (CKG) together with electrocardiograms (ECGs) may help to detect "silent" heart disease. A comparison study revealed that electrocardiograms alone dismissed 39% of heart disease cases. When CKG was used with ECGs, only 8% of cases were undetected.

• Nitroglycerine, which is sold in sublingual tablet, patch, and lingual spray form, is commonly prescribed to relieve chest pain and to improve oxygen supply to the heart.

The drug is taken at the first sign of pain. If dry mouth prevents sublingual nitroglycerine tablets form dissolving, the spray form may be a better choice. Nitroglycerine has some side effects, including headache, weakness, and dizziness. These usually disappear with continued use.

Diet change strategies:

Herbal Nutrition and weight control.

The problem with difficulties with your cardio vascular system can be from many causes as we have seen above.

Many, many people can be greatly helped with weight control and sensible diets. The other major products that can save lives are Omega 3 & 6 fatty acids and Nitrous Oxide.

Firstly weight control

In recent years, several specific cholesterol-lowering treatments have gained the attention and interest of the public. One of the most recent popular treatments is garlic (Allium sativum). Some studies have shown that garlic can reduce total cholesterol by about 10% and LDL (bad) cholesterol by 15%, and can raise HDL (good) cholesterol by 10%.

Other studies have not shown significant benefit. Although its effect on cholesterol is not as great as the effect achieved by medications, garlic may help in relatively mild cases of high cholesterol, without causing the side effects associated with cholesterol-reducing drugs.

Traditional Chinese medicine may recommend herbal remedies (such as a ginseng and aconite combination), massage, acupuncture, and dietary modification. Exercise and a healthy diet, including cold-water fish as a source of essential fatty acids, are important components of a regimen to prevent angina and heart disease.

Allopathic treatment

Angina is often controlled by medication, most commonly with nitroglycerin. This drug relieves symptoms of angina by increasing the diameter of the blood vessels that carry blood to the heart muscle.

Nitroglycerin is taken whenever discomfort occurs or is expected. It may be taken sublingually, by placing the tablet under the tongue. Or it may be administered transdermally, by placing a medicated patch directly on the skin.

In addition, beta-blockers or calcium channel blockers may be prescribed to decrease the heart's rate and workload. In late 2001, a study reported that the drug Nicorandil had become the first to demonstrate a reduction in risk of angina and to improve symptoms in patients with chronic stable angina.

Guidelines released late in 2000 promoted use of lopidogrel to help prevent recurring events.

A study group that used clopidogrel and aspirin showed a significant decrease in cardiovascular death, nonfatal heart attack, and stroke compared to patients in a control group that received a placebo and aspirin.

When conservative treatments are not effective in reducing angina pain and the risk of heart attack remains high, physicians may recommend angioplasty or surgery. In coronary artery bypass surgery, a blood vessel (often a long vein surgically removed from the leg) is grafted onto the blocked artery to bypass the blocked portion. This newly formed pathway allows blood to flow adequately to the heart muscle.

Another procedure used to improve blood flow to the heart is percutaneous tranluminal coronary angioplasty, usually called coronary or balloon angioplasty. In this procedure, the physician inserts a catheter with a tiny balloon at the end into a forearm or groin artery.

The catheter is then threaded up into the coronary arteries, and the balloon is inflated to open the vessel in narrowed sections. Other techniques to open clogged arteries are under development and in limited use, including the use of lasers, stents, and other surgical devices.

Diet change strategies:

One of the major factors causing Angina problems is carrying excess weight. Every kilogram of fat you are carrying. For every kilo of excess body fat you car carrying there are approx 27,000 kilometers of additional blood vessels needed to carry the blood through it!

If you have problems with your heart or your Cardiovascular system then you need to help yourself with reducing the stress, dropping excess weight.

Another major nutritional support for your Cardiovascular system is Omega 3 and Omega 8 fatty acids.

If you have problems with circulation then you will be amazed at the support Omega fatty acids can give you.

Finally there is a lot of new information about Nitric Oxide and what it can do to support your Cardiovascular health. Dr Louis Ignarro won a Nobel Prize for his work in this area. This is an exciting new area in the field of dealing with cardiovascular problems and one worth looking into.

A combination of getting your weight right, clearing out your arteries and then using sensible diet and sensible exercise can make a life changing and often live saving difference to your situation

Free Report Reveals the “ABC’s of Heart Disease” See how easy it is Dealing with Coronary Disease for your Health Success Free Health Book. If you have heart disease or are at risk, learn all you can about how the heart works and why heart disease occurs. Click the link above or book cover to get your free Report & eCourse today!

Heart disease
The term coronary heart disease covers a group of clinical syndromes arising particularly from failure of the coronary arteries to supply sufficient blood to the heart. They include angina peactoris, coronary thrombosis or heart attack and sudden death without infarction.

There has been a marked increase in the incidence of heart disease in recent years. Heart attacks have become the number one killer in Western countries. The disease affects people of all ages and both sexes, although it is more common in men than in women, especially among those aged 40-60 years.

Blood Pressure
Perhaps one of the most common problems human beings face today in terms of their biology is that of blood pressure. The pressure exerted by blood pumping through a human body can change rapidly due to so many different reasons.

Thus, it has become commonplace for medical practitioners to check a patient's blood pressure as one of the first tests when a problem occurs.

Preventing High Blood Pressure with Weight Loss
No doubt, there are number of treatments and medicines available for the treatment of high blood pressure. But as it is said, “Precaution is better than cure”. So, we must consider this saying and follow the recommended rules in order to prevent the high blood pressure.

Blood pressure is directly proportional to the body weight; it means that if your weight increases the blood pressure also rises. Overweight people have an increased risk of high blood pressure, heart disease, and other illnesses. Losing weight reduces the risk

We also feature new health articles & self care solutions every month in “Your Health Success” our FREE Health Magazine, so subscribe today to stay up-to-date!

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