What is Angina?

Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Patients report that angina usually feels like a pressure or a squeezing pain in their chest. The pain also often occurs in the shoulders, arms, neck, jaw, and/or back. Some patients also report a feeling similar to indigestion.

What Causes Angina?

Angina is a symptom of a illness called coronary artery disease (CAD). This is also the most common type of heart disease. CAD happens when plaque builds up in the coronary arteries of the body. If you have CAD the arteries that carry oxygen-rich blood to the heart muscle begin to narrowed due to the buildup of fatty deposits in your blood called plaque. This buildup of plaque is referred to as atherosclerosis. As plaque builds up in the coronary arteries, they begin to become stiff and narrow. When this happens the blood flow to the heart is reduced. This will in turn decreases the oxygen supply to the heart muscle. There are two categories of plaque. The first type of plaque is hard and stable and leads to narrowing and hardening of the arteries. The second type of plaques are soft and these are more likely to break open and cause blood clots in the blood stream. The buildup of plaque on the inner walls of the arteries can cause angina in two ways:

    1. Narrowing of the artery/arteries to the point of greatly reduced blood flow.
    2. The formation of blood clots may partially or totally block the artery/arteries.

There are other types of heart disease or uncontrolled high blood pressure that can also cause angina. If you suspect you have this problem you should contact your health care professional immediately to rule out any serious health complications.

Types of Angina

There are three types of angina. They are classified as stable, unstable, and variant. In order to properly treat these conditions you must first know the difference. It is very important to know the differences among the types.

 1. Stable angina. This is the most common type of angina. There is a recognizable pattern to stable angina. It usually occurs when the heart is working harder than usual. Physical exertion is most often the cause of pain and discomfort from stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you are sitting). But with exertion like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. After several episodes, you learn to recognize the pattern and can predict when it will occur. The pain will usually go away in a few minutes when you rest or take an angina medication. Stable angina is not a heart attack but it is more likely that you will have a heart attack in the future. Other causes may include:

    Emotional or psychological stresses
    Rapid changes in environment such as exposure to very hot or cold temperatures
    Heavy meals
    Smoking
   
2.Unstable angina. Unstable angina is a very dangerous condition that requires emergency treatment. It is an outwardly observable sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern that is regular. It can occur without any physical exertion and is not usually relieved by rest or medication. Unstable angina is caused by a blood clot/clots that are partially or totally blocking an artery. If the plaque in the affected artery ruptures blood clots can form. This may create a larger blockage and can grow large enough to completely block the artery. This will usually result in a heart attack if not properly attended to promptly by your health care provider. Blood clots may form and dissolve or partially dissolve only to form again later. Chest pain can occur each time this happens and a clot can block an artery.

3.Variant angina. Variant angina is rare. It usually occurs when a person is at rest. It is most commonly reported by patients to occur between the hours of midnight to eight in the morning. It is usually relieved by medication. Variant angina is caused by a "spasm" of a coronary artery. This spasm causes the walls of the artery to tighten and narrow the artery. As a result the blood flow to the heart slows or stops. This type of angina can occur in persons with or without CAD. Other causes of spasms in the arteries that supply blood to the heart are:

    Exposure to cold and/or heat
    Emotional and or physical stress
    Medications that constrict or narrow the blood vessels
    Cigarette smoking
    Cocaine/Illegal drug use
 

Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

What Are the Common Signs and Symptoms of Angina?

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur. Symptoms will vary based on the type of angina that you have.

• It typically occurs when the heart must work harder usually during physical exertion.
• It is usually expected and episodes of pain tend to be alike.
• The attacks usually last a short time (5 minutes or less).
• It is usually relieved by rest or angina medicine.
• Many patients report a feeling of gas or indigestion.
• May feel like chest pain that spreads to the arms, back, or other areas.

 
Unstable Angina

    Often occurs when at rest while sleeping at night or with little physical exertion.
    It occurs unexpectedly.
    Is more severe and lasts longer (as long as 30 minutes) than stable angina episodes
    It is usually not relieved with rest or angina medications.
    Can get continuously worse over time.
    May be a signal that a heart attack will happen soon.

 
Variant Angina

    Usually occurs at rest and during the late night to early morning hours.
    The pain tends to be more severe in nature.
    It is usually relieved by angina medications.

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medications may mean you are having-or- are about to have a heart attack. Get emergency help right away.

 
How is Angina Treated?

With the exception of unstable angina which is an emergency condition that requires prompt medical attention. A combination of conventional medications, natural medicine, TCM (Traditional Chinese Medicine), diet and nutrition, as well as exercise, surgery and rehabilitation are the obvious answer to this serious health concern. Lifestyle changes and medication (western , herbal or Chinese herbals) may be the only treatments needed if your symptoms are mild and are not getting worse.

The main goals of the above listed treatments are to:

    Reduce the frequency and severity of symptoms.
    Prevent or lower the risk of heart attack and/or death.

Lifestyle Changes

Education, counseling, and training are the keys to help you understand your heart condition and find ways to reduce your risk of future heart problems. Your professional health care provider can help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future. The staff of East West Center for Natural Medicine are happy to assist you in this endeavor. For further information please call 574-210-4982.

The first change in your living habits that you might want to consider in order to prevent or avoid further episodes of angina are:

• If angina is experienced upon exertion, take a break or slow down.
• Avoid large heavy meals and rich foods that leave you feeling to full.
• Try to avoid situations that make you upset or stressed and learn techniques to handle stress that can't be avoided. For example, Tai chi, meditation and Qi gong techniques.

 
Other changes that you might want to consider are:

• Diet & Nutrition are ways to prevent or reduce high blood pressure and high blood    cholesterol, and obesity that affect angina directly. Adding fruits a vegetables high in vitamin E, A and C are essential to help keep your heart and circulatory system healthy. As well as potassium, selenium, calcium, magnesium and chromium.

• If you are a smoker quit immediately.

• Exercise as directed by your health care provider.

• Lose weight if you are overweight.

• If you have diabetes follow your health care professional's orders and take all medications as directed.

Medications

Western physicians most often prescribe Nitrates for angina patients. For example, the drug "Nitroglycerin" is widely used. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload. Other medicines used to treat angina include Beta blockers, Calcium channel blockers and Ace inhibiters, oral antiplatelet medicines (such as aspirin or clopidigrel), and anticoagulants.

• Natural medicines and Herbs that may also be used by people with angina include: Astragalus, Dan Shen, Dong Quai, Hawthorn, Kudzu, and cactus, Fu Fang Dan Shen Pian and Huo Xue Tong Mai Pian.
• Herbs and Natural Medications that help to lower cholesterol levels are: Hawthorn, Alfalfa, Evening primrose oil and Shan Zha Jiang Zhi Pian.
• Herbs and Natural medications that help to lower high blood pressure are: Cayenne, Garlic, Hawthorn, Tian Ma Gou Teng Pian, and Jiang Ya Pian.
•  Oral antiplatelets are taken daily to stop platelets from clumping together to form blood clots. Platelets are small blood cell fragments that circulate through your blood vessels and help stop bleeding by sticking together to seal small cuts or breaks in tiny blood vessels. Antiplatelet medicines may not be appropriate for some people because they increase the risk of bleeding. Discuss the benefits and risks with your doctor before starting therapy with aspirin or the other antiplatelet medicines and or herbs. Some natural forms of antiplatelet herbs and medications are: Bilberry, Ginko, Vitamin E, and Ginger.
• Anticoagulants are used to prevent clots from forming in your arteries and blocking blood flow. Anticoagulant medicines may not be appropriate for some people because they increase the risk of bleeding. Discuss the benefits and risks with your doctor before starting therapy with any anticoagulant medicines and or herbs. Some Natural herbs and medications that have anticoagulant effects are Anise and Dong Quai.

 
Diet & Nutritional Therapy

Please contact East West Center for Natural Medicine for information on the many ways to modify your Diet & Nutrition in ways that best suit your unique health care needs.
It is best to avoid certain foods and beverages. Saturated fats such as meat and dairy products, caffeine, processed foods, and alcohol are known to greatly increase the incidence of this particular health concern.

Consume a variety of fresh vegetables, whole grains, and essential fatty acids (cold-water fish, nuts, and seeds).

 
The following supplements may help reduce symptoms of angina by tonifying the cardiovascular system.

 
    Coenzyme Q10 (50 to 100 mg one to two times per day)
    L-carnitine (330 mg two to three times per day)
    Vitamin E (400 to 800 IU per day)
    Essential fatty acids (1,000 to 1,500 mg one to two times a day)
    L-taurine (100 mg twice a day) and magnesium (200 mg two to three times per day)
    Vitamin C (250 to 500 mg two times per day)
    Bromelain (400 to 1,000 mg per day)
 

Special (Invasive) Procedures

When medicines and other treatments do not control angina, special procedures may be needed. Two commonly used procedures are:

Angioplasty to open blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Coronary artery bypass surgery, which uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Bypass surgery improves blood flow to your heart, relieves chest pain, and can prevent a heart attack.

Cardiac Rehabilitation (Rehab)
Your doctor may prescribe cardiac rehab for angina or after bypass surgery, angioplasty, or a heart attack.
The cardiac rehab team may include:

• Doctors and Nurses, such as your family doctor, heart specialists and or surgeons. 
• Exercise specialists such as a physical therapist, occupational therapist, tai chi or chi gong instructor for gentle and effective exercise.
• Dietitians or Alternative health care professionals trained in food and herbs that will assist in your recovery and further prevention of more health problems.
• Psychologists or other behavior therapists in order to address any issues that may help you learn to cope with the changes in your life and health 

Rehab has two parts:
Exercise training to help you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.

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