There are no truly characteristic symptoms of angina pectoris. Common symptoms include a deep, viselike pain felt beneath the breastbone and over the heart and stomach, that sometimes radiates into the left shoulder and down the inner side of the left arm. A feeling of constriction or suffocation often accompanies the pain, though there is seldom actual difficulty in breathing. In acute cases, the sufferer becomes pale, the pulse is feeble, and there is the feeling that death is imminent. Anginal pain may be quite mild in some cases, but its peculiar qualities can still induce feelings of anxiety in the sufferer.
While the chest discomfort may be variously described as constricting suffocating, crushing, heavy, or squeezing, there are many patients in whom the quality of the sensation is imprecise. The discomfort is usually, but not always, behind the breastbone, but pain radiating to the throat or jaw or down the inner sides of either arm is common. There may be no physical abnormalities, and an electrocardiogram may be normal or show only transient changes with exercise.
cAUSES AND TRIGGERS
Angina is caused by the inability of diseased coronary arteries to deliver sufficient oxygen-laden blood to the heart muscle. The arteries have been narrowed by atherosclerosis, and when insufficient blood reaches the heart, waste products accumulate in the heart muscle and irritate local nerve endings, causing anginal pain.
Attacks of angina can be precipitated, in a person who has a heart disorder, by walking or more strenuous exertion, by a fit of anger, fear, or some other stressful emotional state, by exercising after a heavy meal, or simple from exposure to cold or wind.
As a person coronary artery disease worsens, attacks of angina are apt to recur following less and less exertion. Angina pectoris is rare in persons under middle age and is much more common in males than in females.
The frequency of attacks can be lessened by the avoidance of emotional stress and by shifting to exercise that is less vigorous.
MEDICATIONS AND TREATMENTS
A person stricken with angina is obliged to stop whatever activity he is engaged in, and rest, and after three or four minutes the pain subsides as quickly as it began.
Any medication you take to treat angina must be prescribed by your physician. After studying your specific conditions he will be the best judge of what medication would be most effective. Always follow medical instructions strictly. Stopping or altering your medication without your doctor knowledge can be dangerous to your health.
An anginal attack can be relieved by rest or by taking nitroglycerin or other drugs that relax the blood vessels and increase blood flow to the coronary arteries.
The most common immediate treatment is nitroglycerin. It is taken sublingually or by chewing the tablet and allowing it to be absorbed via the membranes in your mouth. Nitroglycerin is ineffective if swallowed The dose used is based on the individual case and is generally 0.2 to 0.6 mg which may need to be repeated once or twice at 5 minute intervals. Patients generally learn the best balance between pain relief and unpleasant side effects.
B-blockers and calcium channel blockers are two groups of drugs that are useful in angina pectoris. B-blockers have a definite long-term preventive value by virtue of their cardioprotective effects. The most commonly prescribed B-blocker is atenolol. Among calcium channel blockers the most favoured drugs include nifedipine, diltiazem and amlodipine.
In cases where the narrowing of the coronary arteries appears serious enough to cause a heart attack, surgery must be used to widen the passages within the arteries or replace the arteries with unblocked ones from another portion of the body.
POINTS TO REMEMBER
Angina is a result of definite physical factors. However there is a large psychosomatic component in the overall effects that you encounter. Understanding that angina is not necessarily the end of it all, and being aware that, with some adjustments and care, you can continue to lead a full and satisfying life, can help you tremendously.
Emotional responses will trigger the sympathetic nervous system and increase the oxygen requirement of your heart. Thus angina can literally feed on itself. On the positive side, confidence in your doctor and the medications you take can prevent attacks.
Making changes in your lifestyle can improve the quality of your life as will as your chances of living a much longer life. Smoking is a major risk factor and should be stopped. Smoking causes blood vessels to constrict and thus forces your heart to beat faster and increases your blood pressure.
You can make yourself aware of the general state of your health by monitoring certain parameters and acting accordingly. Besides your diet and exercise routines you can also learn to take your pulse from time to time, so that you can be aware of your heart rate changes as they occur.
more light on angina
As already discussed, Angina describes a squeezing or pressure like pain in the chest caused by an insufficient supply of oxygen to the heart muscle. Since physical exertion and stress cause an increased need for oxygen by the heart, they stress cause an increased need for oxygen by the heart, they are often preceding factors. The pain may radiate to the left shoulder blade, left arm, or jaw. The pain typically lasts for only one to 20 minutes.
Angina is almost always due to atherosclerosis, the buildup of cholesterol containing plaque, which progressively narrows and ultimately blocks the blood vessels supplying the heart the coronary arteries. This blockage results in a decreased blood and oxygen supply to the heart tissue. When the flow of oxygen to the heart muscle is substantially reduced, or when there is an increased need by the heart, it results in angina.
Prinzmetal variant angina, a special type of angina that is not related to a buildup of plaque on the coronary arteries, is caused by spasm of a coronary artery. This form of angina is more apt to occur at rest, may occur at odd times during the day or night, and is more common in women under age 50. It usually responds to magnesium supplementation.
Angina is a serious condition that requires strict medical supervision. In severe cases, as well as in the initial stages in mild to moderate cases, prescription medications may be necessary. Eventually, however, the condition should be able to be controlled with natural measures. If there is significant blockage of the coronary artery, chelation therapy may be appropriate.
THE NATURAL APPROACH TO ANGINA
From a natural perspective, the treatment of angina has two primary therapeutic goals : improving energy metabolism within the heart, and improving the blood supply to the heart. These goals are interrelated : An increased blood flow means improved energy metabolism, and vice versa.
The heart utilizes fats as its major metabolic fuel. It converts free fatty acids to energy much as an automobile utilizes petrol. Defects in the utilization of fats by the heart greatly increases the risk of atherosclerosis, heart attacks and angina pains. Specifically, impaired utilization of fatty acids by the heart results in accumulation of high concentrations of fatty acids within the heart muscle. This then makes the heart extremely susceptible to cellular damage, which ultimately leads to a heart attack.
Carnitine, pantethine, and coenzyme Q10 are essential compounds in normal fat and energy metabolism and are of extreme benefit to sufferers of angina. These nutrients prevent the accumulation of fatty acids within the heart muscle by improving the conversion of fatty acids and other compounds into energy. Carnitine is discussed below along with two herbs, hawthorn and khella.
HAWTHORN EXTRACTS IN ANGINA
Hawthorn berry and flowering tops extracts are widely used by physicians in Europe for their cardiovascular activities. Studies have demonstrated hawthorn extracts are effective in reducing angina attacks as well as lowering blood pressure and serum cholesterol levels, and improving heart function in congestive heart failure.
The beneficial effects of hawthorn extracts in the treatment of angina are a result of improvement in the blood and oxygen supply to the heart by dilating the coronary vessels, as well as improvements of the metabolic processes in the heart.
A recent study has shed additional light on how hawthorn extracts enhance heart function. A hawthorn extract standardized for proanthocyanidin content was studied utilizing an experimental model to determine the effects of a substances on heart function during ischemia. Although its effectiveness in this model was less than beta-blockers and calcium channel blockers, two classes of drugs often used in treating angina, there are a couple of distinctions to be made. Foremost, the mechanism by which the drugs work in this model is by improving coronary blood flow and actually reducing the need for oxygen by the heart by reducing its mechanical function. In contrast, hawthorn actually improves the mechanical function of the heart without increasing coronary blood flow.
Evidence that crataegus improves energy metabolism and the utilization of oxygen by the heart was demonstrated by a decrease in accumulated lactic acid. Without oxygen, the heart muscle will shift to the breakdown of sugar for energy, but this can only go so far without oxygen. As a result, pyruvic acid is shunted to lactic acid. Recovery of heart function is inversely related to the level of lactic acid in the heart. The beneficial effects of hawthorn in angina appear to be related more to its ability to improve oxygen utilization, as noted by its ability to reduce heart tissue lactic acid levels, rather than an ability to dilate coronary vessels. In fact, in this most recent study, hawthorn did not improve coronary blood flow.
Evidence that Crataegus improves energy metabolism and the utilization of oxygen by the heart was demonstrated by a decrease in accumulated lactic acid. Without oxygen, the heart muscle will shift to the breakdown of sugar for energy, but this can only go so far without oxygen. As a result, pyruvic acid is shunted to lactic acid. Recovery of heart function is inversely related to the levels of lactic acid in the heart. The beneficial effects of hawthorn in angina appear to be related more to its ability to improve oxygen utilization, as noted by its ability to reduce heart tissue lactic acid levels, rather than an ability to dilate coronary vessels. In fact, in this most recent study, hawthorn did not improve coronary blood flow.
To summarize, hawthorn extracts have exhibited a combination of effects that are of great value to sufferers of angina or other heart problems. The dosage depends on the type of preparation and source material. standardized extracts, similar to those used in Europe are available commercially. These extracts are the preferred form. The dosage for hawthorn extracts standardized to contain 1.8% vitexin-4- rhamnoside or 10% procyanidins is 100 milligrams to 250 milligrams, three times daily.
KHELLA FOR ANGINA
Khella is an ancient medicinal plant native to the Mediterranean region, where it has been used in the treatment of angina and other heart ailments since the time of the pharaohs. Several of its components have demonstrated effects in dilating the coronary arteries. Its mechanism of action appears to be very similar to the calcium-channel blocking drugs.
Since the late 1940s, there have been numerous scientific studies on the clinical effectiveness of khella extracts in the treatment of angina. More specifically, khellin, a derivative of the plant, was shown to be extremely effective in relieving angina symptoms, improving exercise tolerance, and normalizing electrocardiographic tests. This is evident by the concluding statements in a study published in the New England Journal of Medicine in 1951. The high proportion of favorable results, together with the striking degree of improvement frequently observed, has led us to the conclusion that khellin, properly used, is a safe and effective drug for the treatment of angina pectoris.
At higher doses, 120 milligrams to 150 milligrams per day, pure khellin was associated with mild side effects such as anorexia, nausea, and dizziness. Although most clinical studies used high dosages, several studies show that as little as 30 milligrams of khellin per day appears to offer equal results with fewer side effects.
Khella extracts standardized for khellin content are the preferred form. A daily dose of such an extract would be 250 milligrams to 300 milligrams. Khella appears to work very well with hawthorn extracts.