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Angina

Basics

Angina or angina pectoris refers to a temporary chest pain that is caused an insufficient supply of blood to the heart. It may be a feeling of tightness, heaviness, dull discomfort, numbness, burning, pressure, or crushing pain that is usually felt behind the breastbone. It can also spread to the arms, neck, and jaw. But, not all chest pain is angina; only by making a proper diagnosis can the presence of the condition be confirmed. An angina attack is not the same as a heart attack. In a heart attack a portion of the heart receives little or no oxygen for a longer period of time. Without oxygen, that portion of the heart muscle dies. Angina typically occurs after a predictable amount of exercise, and usually lasts no longer than ten minutes. The symptoms are relieved at rest. Medication relieves the pain by briefly dilating the coronary arteries, but this has no effect on the underlying disease. 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. However, patients with angina are at high risk for having a heart attack if their coronary artery disease is not treated. Angina is the major cause of death in the United States, accounting for roughly 24% of all deaths. Over 4 million Americans have angina. Most of those people have learned that by controlling their angina through use of medications, and certain changes in life-style, they can live long, productive, and active lives.

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Symptoms

Angina is usually described as a heavy, crushing 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 it is associated with breathlessness. 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.

The general symptoms are

  •  Pain in the chest
  •  Pain under the breastbone
  •  Pain may radiate to shoulder, arm, jaw, neck, and back
  •  Often described as tightness, squeezing, crushing, burning, and choking.etc.

    It is important to distinguish between the typical stable pattern of angina and "unstable" angina. 

    Commonly a person recognizes that he or she is having angina only after several episodes have occurred, and a pattern has evolved. The level of activity or stress that provokes the angina is somewhat predictable, and the pattern changes only slowly. This is "stable" angina. 

    Instead of appearing gradually, angina may first appear as a very severe episode or as frequently recurring bouts of angina. On the other hand, an established stable pattern of angina may change sharply; it may by provoked by far less exercise than in the past, or it may appear at rest. Angina in these forms is referred to as "unstable angina" and needs prompt medical attention. 

    The term "unstable angina" is also used when symptoms suggest a heart attack but hospital tests do not support that diagnosis. For example, a patient may have typical but prolonged chest pain and poor response to rest and medication, but there is no evidence of heart muscle damage either on the electrocardiogram or in blood enzyme tests.

    If a pattern of stable angina has been present, the development of unstable angina may be signified by a change in the pattern, frequency, or severity. It may also be signified by an increase in the use of nitroglycerin.

Prevention

A person with angina should start an exercise program only with the doctor's advice. Many doctors tell angina patients to gradually build up their fitness level--for example, start with a 5-minute walk and increase over weeks or months to 30 minutes or 1 hour. The idea is to gradually increase stamina by working at a steady pace, but avoiding sudden bursts of effort. The other preventive methods of angina are listed as follows:

  • Do not smoke. 
  • Lose weight if you are over weight. 
  • Eat a low fat diet with a good fiber intake. 
  • Avoid unnecessary stress and learn relaxation techniques. 
  • Do not drink too much.
  • Avoid salt in food.

Causes

Angina is a result of the heart muscles not receiving enough oxygen (via the blood) for the work they are performing. This occurs when the blood vessels, supplying the heart muscles with oxygen, narrow. There are two types of narrowing of the blood vessels: one is Arteriosclerosis, which is the buildup of fatty deposits within the arteries. This narrows the space through which the blood can flow. The other is caused by Vasospasm, which is a spasm (sudden contraction) of one of the coronary arteries that causes it to narrow temporarily. 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. The main cause of narrowing of the blood vessels is age, but cigarette smoking accelerates this. To a lesser extent people with a high cholesterol level, people who are obese (overweight), and diabetics are also more at risk.

Diagnosis

  • New onset pain, pressure, or discomfort in chest, neck, or left arm 
  • Significant shortness of breath 
  • Fainting, severe dizziness, or sudden severe weakness 
  • Fear of death or impending doom 
  • Palpitations, with weakness or breathlessness, that are continuous and last 5-10 minutes 
  • Cold and clammy skin, pallor 
  • Any symptoms the patient thinks may be a heart attack 
  • Unstable vital signs: pulse, BP, or respiration

Dietary Guidelines

  • Eat plenty of fiber, complex carbohydrates, broiled coldwater fish, chicken and turkey, raw vegetables and fresh fruits, garlic and onion.
  • Monosaturated oleic fats like olive oil, staff flower, raw almonds seem to be the best choice of dietary oils.
  • Avoid alcohol, sugar, soft drinks, salt, red meat, fatty dairy-products, margarine, coffee, tea, baking soda, canned vegetables and soups, diet soft drinks, meat tenderizers and softened water.
  • Give up cholesterol rich, animal source foods such as meat, eggs and dairy products.
  • Avoid deep-fried foods and minimize the heating of fats.
  • A low salt diet is recommended

Home Care Suggestions

  • A heart patient has to accept the fact that a change in the usual lifestyle has to be made.
  • Quit smoking altogether.
  • If you are overweight, cut down on fatty stuff and go on a diet.
  • Stop eating food high in cholesterol such as butter, red meats, fats, fried foods, processed “empty calories” foods, eggs and dairy products.
  • Avoid stress and use relaxation techniques or meditation to alleviate tension.
  • Regular low-impact exercise is very effective in releasing stress.

Mind/Body Considerations

  • Learning to relieve stress and effectively relaxing is essential in controlling conditions like angina.
  • Disciplines designed to evoke complete relaxation are very helpful when dealing with conditions like angina.
  • Try to empty your mind of all conscious thoughts.
  • Controlled breathing can also help create a relaxed state.
  • Try to get connected spiritually to the One you believe in.



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