Angina (angina pectoris) refers to a temporary chest pain that is caused by a lack of blood getting to the heart. Angina usually occurs when the heart has to work harder such as during exercise, after eating a big meal, going out in very hot or cold weather, or stressful situations. Angina results from the supply of oxygen, and occasionally other nutrients, being inadequate to meet the metabolic needs of the heart muscle.
The primary cause is atherosclerosis, although platelet aggregation, coronary artery spasm, non-vascular mechanisms such as hypoglycemia, and increased metabolic need (as in hyperthyroidism) can also be important. Atherosclerosis is caused by the buildup of fatty deposits within the arteries. This narrows the space through which the blood can flow. A spasm can occur at any time in some patients, even when they are at rest. This type of angina is called variant or vasospastic angina.
In most cases an attack will last for less than five minutes, but can range from less than 30 seconds to more than 30 minutes. You will learn to recognize your own pattern – that is, when attacks are likely to occur, how long they will last, and what kind of pain you will feel. If your pattern of pain changes, you should notify your doctor.
The diagnosis of angina is frequently made by history alone. Clinical evaluation of all patients with angina should include an electrocardiogram (EKG) at rest and a chest x-ray. Since more than one-half of patients with typical angina and confirmed coronary atherosclerosis have normal EKG readings at rest, diagnosis must often be confirmed using EKG stress testing or Holter monitoring.
An angina attack is not a heart attack. A heart attack is when a portion of the heart receives little or no oxygen for a longer period of time – without oxygen, that portion of the heart muscle starts to die. If angina is left untreated then a heart attack could result. Angina requires prompt attention by a doctor when the condition first develops or later, if the usual pattern of attacks changes. Be sure to contact your physician if your angina attacks begin to occur more often, are brought about by less strenuous activities than usual, last for a longer time, or feel different in any other way.
If your angina pain does not go away after you have taken three sublingual nitroglycerin tablets within ten minutes, seek emergency medical care. The symptoms of a heart attack are usually stronger than those of angina. Signs that a person is having a heart attack and should get emergency attention include: pain lasting more than 30 minutes, sweating, nausea, shortness of breath, severe anxiety, and fatigue. Most people who suffer a fatal heart attack do so because they did not get help soon enough. So, if you think you are having a heart attack, contact your doctor, call an ambulance, or get to a hospital immediately. Do not hesitate to seek help; it is always better to be safe than sorry.
Signs, symptoms & indicators of Angina
Pain in chest or left side
Counter Indicators
Asbsence of chest or left sided pain
Heartburn
Angina-like symptoms are sometimes due to heartburn, a much less serious condition.
Radiating/deep chest pain
(Possible) exertional chest pain
Pain/burning behind breastbone
Chest tightness
Chest pressure
Counter Indicators
Chest pain unrelated to exertion
Conditions that suggest Angina
Having angina
Risk factors for Angina
Dehydration
Dr. Bantmanghelidj, MD in his book Your Body’s Many Cries for Water reports testimonials of angina reduction with adequate hydration.
Mercury Toxicity / Amalgam Illness
Mercury poisoning may be causing chest pain or angina, especially in anyone under age 45.
History of angina
Counter Indicators
Absence of angina
Past pain/burning behind breastbone
Angina can lead to
Recommendations for Angina
See a Doctor at Earliest Opportunity
As angina is a serious symptom, if you have not already seen a doctor about this, it is important to do so.
L-Carnitine
Several clinical trials have demonstrated that carnitine supplementation improves angina and heart disease. Improvements have been noted in exercise tolerance and heart function. In one study of patients with stable angina, oral administration of 900mg of L-carnitine increased mean exercise time and the time necessary for abnormalities to occur on a stress test.
These results indicate that carnitine may be an effective alternative to other anti-angina agents, especially in patients with chronic stable angina. [ Drugs Exp Clin Res 1991;17(4): pp.225-35, Eur Heart J 1996 Mar;17(3): pp.414-20]
Arginine
Oral administration of L-arginine (700mg qid during continuous transdermal nitroglycerin therapy) increased treadmill walking
time until the onset of moderate angina in a small well-controlled trial. [J Am Coll Cardiol 2002;39(7): pp.1199-1203]
Garlic
When taken in high doses, garlic increases fibrinolytic activity. This increased fibrinolytic activity inhibits platelet aggregation which contributes to the formation of blood clots.
Bromelain
Research has indicated that bromelain prevents or minimizes the severity of angina pectoris. A reduction in the incidence of heart attacks after administration of potassium and magnesium orotate along with 120-400mg of bromelain per day has been reported also. [J IAPM 1979;6: pp.139-151</>]
D-Ribose
Please see the link between Heart Disease and Pomegranate.
Aerobic Exercise
A carefully graded, progressive, aerobic exercise program (30 minutes 3 times per week) is a necessity. Walking is a good exercise with which to start. Since angina is known to be exacerbated by physical exertion following a meal, give your body at least one and a half hours after a meal before exercising.
Tests, General Diagnostic
Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it’s at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed. During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.
Magnesium
Magnesium insufficiency-induced coronary artery spasm, more common in men than women, is now recognized as an important cause of myocardial infarction and may be of significance in angina pectoris.
Oral magnesium supplementation (700 – 800mg per day) can improve exercise tolerance and reduce exercise-induced chest pain in patients with coronary artery disease. [Am J Cardiol 2003;91: pp.517-521]
CoQ10 (Ubiquin-one/ol)
CoQ10 deficiency is common in individuals with heart disease. Heart tissue biopsies in patients with various heart diseases show a CoQ10 deficiency in 50 to 75% of cases. In one study, patients with stable angina pectoris were treated with CoQ10 at 150 mg per day for four weeks. Compared to placebo, CoQ10 reduced the frequency of anginal attacks by 53%. In addition, there was a significant increase in treadmill exercise tolerance. The results of this study and others suggest that CoQ10 is a safe and effective treatment for angina pectoris.
Pantethine
Heart pantethine levels decrease during times of reduced oxygen supply. Demonstrated effects in animals indicate that it would be beneficial to individuals with angina. The typical dose is 900mg per day.
Stress Management
Stress should be decreased by using stress management techniques such as progressive relaxation or guided imagery.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Angina
Angina pectoris. Severe, restricting chest pain with sensations of suffocation caused by temporary reduction of oxygen to the heart muscle through narrowed diseased coronary arteries.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Spasm
Involuntary contraction of one or more muscle groups.
Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
Hyperthyroidism
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Electrocardiogram
A test that shows a tracing of the electrical conduction of the heart.
Sublingual
Situated or administered under the tongue, for example sublingual glands or sublingual tablets.
Nausea
Symptoms resulting from an inclination to vomit.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.