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Angina Pectoris (Chest Pain) | | Description |
Chest pain due to reduced blood flow to the heart is known as angina or
angina pectoris. Hardening of the coronary arteries (atherosclerosis) that
feed the heart is usually the underlying problem; it is important for
treatment and prevention of angina (and for overall health) to learn more
about atherosclerosis. Coronary artery spasms may also cause
angina.
There are three main types of angina. The first is called
stable angina. This type of chest pain comes on during exercise and is
both common and predictable. Stable angina is most often associated with
atherosclerosis. A second type, called variant angina, can occur at rest
or during exercise. This type is primarily due to sudden coronary artery
spasm, though atherosclerosis may also be a component. The third, most
severe type is called unstable angina. This angina occurs with no
predictability and can quickly lead to a heart attack. Anyone with
significant, new chest pain or a worsening of previously mild angina must
seek medical care immediately.
What are the symptoms of angina?
Common symptoms of angina include a squeezing pressure, heaviness, ache,
or burning pain (like indigestion) in the chest that occur for 5 to 30
minutes at a time. These sensations are usually felt behind the breastbone
but may also be felt in the jaw, neck, arms, back, or upper abdomen. Some
people may also have difficulty in breathing or may become pale and
sweaty. Symptoms of angina usually appear during physical exertion, after
heavy meals, and with heightened emotional states, such as anger,
frustration, shock, and excitement.
Conventional treatment options:
Nitroglycerin (e.g., Nitro-Bidr, Nitro-Durr, Transderm-Nitror, and others)
is available as pills to be held under the tongue or as a patch to be
applied to the skin. The drug is used to temporarily widen the blood
vessels in the heart to prevent or stop an angina attack. Smoking is
discouraged, since nicotine prevents proper blood flow. In advanced
stages, surgical repair of the blood vessels in the heart may be
recommended. In some situations, treatment is directed toward underlying
medical conditions, such as high cholesterol, high blood pressure, anemia,
hyperthyroidism, obesity, or lung disease.
Dietary changes that may
be helpful: Coffee should probably be avoided. Drinking five or more cups
of coffee per day has been shown to increase the risk of angina, although
effects of different forms of coffee on angina are
unclear.
Lifestyle changes that may be helpful: Cigarette smoking
causes damage to the coronary arteries and, in this way, can contribute to
angina. It is critical for anyone with angina who smokes to stop smoking.
Smoking has also been shown to reduce the effectiveness of treatments for
angina. Secondhand smoke should be avoided as well.
Increasing
physical exercise has been clearly demonstrated to reduce symptoms of
angina, as well as to relieve its underlying causes. One study found that
intense exercise for ten minutes daily was as effective as beta-blocker
drugs in a group of patients with angina. Anyone with angina or any other
heart condition, as well as anyone over the age of 40, should consult a
doctor before beginning an exercise program.
Nutritional
supplements that may be helpful: L-carnitine is an amino acid needed to
transport fats into the mitochondria (the place in the cell where fats are
turned into energy). Adequate energy production is essential for normal
heart function. Several studies using 1 gram of L-carnitine two to three
times per day showed an improvement in heart function and a reduction in
symptoms of angina. Coenzyme Q10 also contributes to the energy-making
mechanisms of the heart. Angina patients given 150 mg of coenzyme Q10 each
day have experienced greater ability to exercise without experiencing
chest pain. This has been confirmed in independent
investigations.
Low levels of antioxidant vitamins in the blood,
particularly vitamin E, are associated with greater rates of angina. This
is true even when smoking and other risk factors for angina are taken into
account. Early short-term studies using 300 IU (International Units) per
day of vitamin E could not find a beneficial action on angina. A later
study supplementing small amounts of vitamin E (50 IU per day) for longer
periods of time showed a minor benefit in people suffering angina. Those
affected by variant angina have been found to have the greatest deficiency
of vitamin E compared with other angina patients.
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. Blood cells in people with angina are known to make
insufficient nitric oxide, which may in part be due to abnormalities of
arginine metabolism. Taking 2 grams of arginine three times per day for as
little as three days has improved the ability of angina sufferers to
exercise. Seven of ten people with severe angina improved dramatically
after taking 9 grams of arginine per day for three months in an
uncontrolled study. Detailed studies have investigated the mechanism of
arginine and have proven it operates by stimulating blood vessel
dilation.
N-acetyl cysteine (NAC) may improve the effects of
nitroglycerin in people with angina. People with unstable angina who took
600 mg of NAC three times daily in combination with a nitroglycerin
transdermal (skin) patch for four months had significantly lower rates of
subsequent heart attacks than did people who used either therapy alone or
placebo.
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; other
investigators could not confirm these findings. People who take fish oil
may also need to take vitamin E to protect the oil from undergoing
potentially damaging oxidation in the body. It is not known how much
vitamin E is needed to prevent such oxidation; the amount required would
presumably depend on the amount of fish oil used. In one study, 300 IU of
vitamin E per day prevented oxidation damage in individuals taking 6 grams
of fish oil per day.
Magnesium deficiency may be a contributing
factor for spasms that occur in coronary arteries, particularly in variant
angina. While studies have used injected magnesium to stop such attacks
effectively, it is unclear whether oral magnesium would be effective in
preventing or treating blood vessel spasms.
Bromelain has been
reported in a preliminary study to relieve angina. In that study, 600
people with cancer were receiving bromelain (400 to 1,000 mg per day).
Fourteen of those individuals had been suffering from angina. In all 14
cases, the angina disappeared within 4 to 90 days after starting
bromelain. However, as there was no control group in the study, the
possibility of a placebo effect cannot be ruled out. Bromelain is known to
prevent excessive stickiness of blood platelets, which is believed to be
one of the triggering factors for angina.
Are there any side
effects or interactions? Refer to the individual supplement for
information about any side effects or interactions.
Herbs that may
be helpful: The fruit, leaves, and flowers of the hawthorn tree contain
flavonoids, including oligomeric procyanidins, which may protect blood
vessels from damage. A 60 mg hawthorn extract containing 18.75% oligomeric
procyanidins taken three times per day improved heart function and
exercise tolerance in angina patients in a small clinical
trial.
Khella is an African plant that contains spasm-relieving
compounds, including khellin. Purified khellin was shown to be helpful in
relieving angina in preliminary studies in the 1940s and 1950s. It is
unknown whether the whole herb would have the same effects. Due to the
potential side effects of khella, people with angina should consult with a
physician knowledgeable in botanical medicine before taking
it.
Kudzu is used in modern Chinese medicine as a treatment for
angina. Standardized root tablets (10 mg tablet is equivalent to 1.5 grams
of the crude root) are sometimes used for angina pectoris in the amount of
30 to 120 mg per day.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or
interactions.
Other integrative approaches that may be helpful:
People suffering from angina may find acupuncture to reduce symptoms, the
need for medication, and even the need for invasive surgery. While some
studies of acupuncture treatment for angina found no benefit, others have
demonstrated positive results. An uncontrolled trial of 49 angina patients
found that acupuncture resulted in 58% less nitroglycerin use and a 38%
decrease in the number of angina attacks. In another study, 69 patients
suffering with severe angina were treated with a combination of
acupuncture, shiatsu (acupressure), and lifestyle changes. The results
were compared to patients with severe angina treated with coronary artery
bypass grafting (CABG). The incidence of heart attack and death was 21%
among those treated with CABG and 7% among those treated with the combined
therapy including acupuncture. In addition, 61% of those treated with the
combination therapy, because of their improved health, postponed any
further invasive treatment. In a single-blind study of 26 patients, a
reduction in angina attack rate and nitroglycerin use, as well as an
improvement in exercise performance, occurred in the treatment group
compared to a sham (fake) acupuncture group. Findings from a controlled
trial comparing acupuncture treatment (three treatments per week for four
weeks) to placebo tablets support these results, demonstrating a reduction
in the number of angina attacks, improved exercise performance, and
corresponding improvements in ECG readings.
Transcendental
meditation (20 minutes twice daily of silently chanting a mantra with eyes
closed) was found in a small controlled trial to reduce angina-like chest
pain and to normalize electrocardiograms (ECGs) in patients with cardiac
syndrome X, a form of angina in people with otherwise normal coronary
arteries. While these patients did not have angina in the classic sense,
their chest pain was thought to result from anxiety, which may reduce
blood flow to the heart, and their ECGs resembled those of classic angina
patients. It is not yet known whether transcendental meditation would have
the same effect on patients with angina pectoris.
Evidence from
preliminary and controlled studies suggests that there may be a
relationship between the presence of heart disease and changes to the
muscles and joints of the spine that are detectable by practitioners of
spinal manipulation. In a double-blind study, patients with proven
coronary disease were more likely to have specific changes in their spine
detectable by palpating or "feeling" their backs than were
subjects who were healthy. Controlled studies have demonstrated that
manipulation of the joints in the middle of the neck can increase heart
rate, respiratory rate, and blood pressure, but manipulation of the lower
neck does not appear to have the same effect. Despite these intriguing
findings, there is no research investigating whether manipulation reduces
angina symptoms or otherwise benefits the heart and cardiovascular system.
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A Selection of Products that may be useful for Angina Pectoris (Chest Pain).
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