Angina Symptoms and Treatment
By Alice Foster
Angina is chest pain caused by the heart tissues not getting enough oxygen. This is usually a result of atherosclerosis, a buildup of cholesterol containing material that blocks the heart arteries. The most common type of angina is called stable angina, characterized by chest pain primarily upon exertion (usually relieved by the drug nitroglycerin). In unstable angina, the symptoms are worse, more frequent, and pain may occur with light activities or even at rest, which is a sign of impending disaster. A rarer form of angina is called Prinzmetal or variant angina, occurs mostly in women, and is caused by spasm of the heart arteries rather than blockage.
- Squeezing or pressure-like pain in the chest that may radiate down the arm or to the jaw
- Indigestion-type symptoms
- Shortness of breath
What You Need to Know
Angina itself causes no permanent damage, but it is a sign that the heart is diseased. Not treating the angina and underlying heart disease can lead to heart attack and death. If you smoke cigarettes, stop, because the heart arteries cannot heal if you continue smoking. Also avoid excessive coffee drinking, which can worsen angina. If you have high cholesterol, you must reduce it to normal to stop clogging your heart arteries.
Diet: In addition to eating a balanced diet, you need to increase dietary fiber (eat more veggies) and eat at least two meals of fish per week (cold-water fish such as mackerel, salmon, halibut, tuna, herring, or cod) to reduce or prevent cholesterol buildup in the heart arteries. Avoid, or at least limit, saturated fats, foods high in cholesterol, and animal proteins, all of which increase cholesterol buildup in the heart arteries. I also recommend drinking one glass of wine daily with meals. Wine, especially red, has powerful antioxidant properties.
Exercise: Exercise is important because it helps you improve the ability of your cells to use oxygen efficiently, which reduces symptoms. Before starting an exercise program, however, you should have an exercise tolerance test (ETT) to determine your safe exercise level. On the basis of the test results, your doctor can advise you on a carefully graded, progressive aerobic exercise program.
Unstable angina is considered an emergency and you should see a physician immediately. Cardiac catheterization should be done, and if there is significant blockage of the heart arteries, the following steps are recommended:
Step 1: Procedures for unstable angina
There are three procedures that can be done for unstable angina if you have blockage of your heart arteries:
- Angioplasty involves using a catheter to clean out the artery.
- Stenting is a procedure that places a small device that holds the artery walls open to increase blood flow. This procedure is commonly used with specific drugs to improve survival rate. Additional external radiation is often used with this procedure to activate substances in the catheter/stent to prevent recurrences of the blockage.
- Coronary artery bypass grafting (CABG) involves major surgery to open the chest and replace clogged arteries with veins taken from the legs. A recent study showed that CABG may be slightly better than angioplasty to reduce symptoms, but only in the hands of a skilled surgeon.
The choice from these three procedures depends on the skills and experience of your cardiologist, the condition of your heart arteries, and other medical conditions that you may have. Even though these procedures will reduce your symptoms, they alone do not pro long life. Once your angina is stabilized, you should use the steps described under “Stable Angina” and “General Recommendations”.
If you undergo angioplasty or stenting, your doctor will probably prescribe the medication clopidogrel (Plavix) with an aspirin every day to reduce your risk of heart attack. Also take B vitamins and fish oil to reduce the risk of the artery reclogging. Take the following:
- Fish oil, 1,000 mg daily
- Folic acid, 1 mg daily
- Vitamin B12, 400mcg daily
- Vitamin B6, 10 mg daily
However, Do Not Take antioxidant vitamins, C, E, and beta-carotene, because they interfere with the artery repair process following angioplasty.
Step 2: Take N-Acetylcysteine with Nitroglycerin
If you already have unstable angina, you probably have taken nitroglycerin to reduce your symptoms. Adding N-acetylcysteine (600mg three times daily) to transdermal nitroglycerin has been found to be very beneficial in stabilizing angina in many people. It can be tried if the above procedures are not done or do not fully reduce your anginal symptoms. However, headaches can occur with nitroglycerin and can become even more severe with the addition of N-acetylcysteine.
Step 3: Undergo Heparin Treatment
In the first 30 days of an unstable anginal attack, injecting the drug low-molecular-weight hepann (LMWH) is beneficial in preventing a heart attack, but beyond the 30 days, the benefit is less clear. You should consult your cardiologist to find out whether you are a candidate, and, if so, how much you should take and for how long.
Step 4: Take Aspirin and Vitamin C Daily
Aspirin reduces the risk of heart attack and death in unstable angina. You should take no more than 325mg per day because increased doses can cause harm, and they provide no additional benefit (81mg is a sufficient dose). Aspirin may cause bleeding complications if taken with LMWH. If you are sensitive or allergic to aspirin, your doctor may prescribe the drug ticlopidine instead for the same effect. Take vitamin C, 600 mg per day, to maintain your body’s stores of vitamin C (which aspirin depletes).
Caution: Ibuprofen blocks the blood-thinning effects of aspirin, so try not to take it if you are taking aspirin. If you must take ibuprofen, take the aspirin first, and wait at least an hour to take the ibuprofen, and take the lowest ibuprofen dose you can.
Intravenous chelation therapy has been used by thousands of patients with angina, many of whom have reported resolution of most or all symptoms. Currently, there have been no definitive studies that prove intravenous chelation’s benefits for angina, only these anecdotal reports. In fact, in a recent double-blind study, IV chelation was no better than placebo. The cost is approximately $2,500 to $4,000 and is not covered by insurance. I do not recommend this form of chelation at this time. If you desire chelation anyway, go to Step 7 for an alternative.
Step 5: Take the appropriate prescription medications
Because angina can become unstable if not controlled properly, I recommend beginning with the conventional medications that have been proven effective. I would then try the following steps, and if your symptoms are improved, then it will be safer for you to decrease the dosages or stop taking these conventional drugs, with the guidance of your doctor.
- For acute anginal symptoms that occur occasionally, your doctor can prescribe nitrates, such as nitroglycerin tablets under the tongue (sublingual) or as a spray. Oral or transdermal (skin patch) nitrates can be used longer term, but you can develop a resistance, which decreases their effectiveness. This problem may be reversed by taking vitamin E (200 IU three times daily) so that you can continue using these medications.
- For chronic angina, your doctor may prescribe beta-blockers (such as propranolol, atenolol, metoprolol, or nadolol) or calcium channel blockers (such as dihydropyridine, diphenylalklylamine, or benzothiazepine), to provide long-term relief or prevention of your symptoms. These drug types may be used together, depending on the severity and frequency of the angina. The particular formulation and dosage should be determined with your physician.
These drugs should reduce anginal symptoms very quickly (usually within a few days), which is another reason I recommend them first. Beta-blockers can also help prevent heart attacks, so they serve two good purposes. But in some men, beta-blockers can cause HDL cholesterol to drop to harmfully low levels (less than 35mg/dl). If this side effect occurs, you should take chromium picolinate, 200mcg three times per day, which can increase HDL levels by 10 percent.
Step 6: Take L.Carnitine and Coenzyme Q10 (CoQ10)
If you still have anginal symptoms that step 1 does not fully control, you can take L-carnitine (500mg three times daily) and/or Coenzyme Q10 (CoQ10) (150mg to 300mg daily) in combination with prescription drug therapies. These supplements allow the heart to utilize oxygen more efficiently. It may take several weeks to notice improvement. If these supplements improve your symptoms, you may then be able to reduce the dosages of your prescription medications. However, consult with your doctor before doing so.
Step 7: Take L-Arginine
If your symptoms continue after trying step 2, you can take L-arginine (3g three times a day), which improves symptoms and cardiac function in patients with angina by augmenting nitric oxide in the blood (thus helping open their arteries). You can take this supplement along with the supplements in step 2 to further improve your condition.
Step 8: Take Magnesium for Prinzmetal Angina
If spasm of the heart blood vessels (Prinzmetal angina) causes your symptoms, take magnesium, 200mg to 400mg three times daily.
Step 9: Take the Herbs Hawthorn and Khella for Heart Failure with Angina
Many people who have angina also have heart failure. Once your heart failure is controlled by conventional medications, consider taking hawthorn, an herb that dilates coronary arteries and thus improves oxygen flow to the heart. Hawthorn can be beneficial if you have angina along with NYHA (New York Heart Association) stage I or stage II heart failure, in which you are comfortable at rest but ordinary physical activity results in fatigue, palpitation, breathing problems, or angina. However, if used with other conventional heart medications, hawthorn can possibly either increase the effect or interfere with these medications, so check with your doctor before taking it. The dosage is 100mg to 250mg of extract containing 1.8 percent vitexin-4′rhamnoside or 10 percent procyanidin content, three times a day.
Another herb, khella, dilates the coronary blood vessels. Khella may be beneficial if the above medications are not helpful, or in combination with them if they are only partially effective. Dosage is 100mg of powdered extract containing 12 percent khellin, three times daily. These herbs may take several weeks to reduce anginal symptoms, although you may observe results even sooner.
Step 10: For Continued Angina, Add Homeopathic Remedies
Homeopathic remedies, such as Nux vomica or Arsenicum album, can sometimes relieve angina that fails to respond to other measures. You should consult a qualified homeopathist for guidance on which remedies will be most beneficial and on proper dosages. Your symptoms should improve within one to two weeks.
Step 11: Take Malic Acid or Cilantro for Prevention or Recurrence of Angina
Many alternative practitioners believe that various metals accumulate in our bodies and cause atherosclerosis and angina. They recommend intravenous chelation, a process in which a specific substance (called EDTA) is injected into your bloodstream and binds to these metals and helps the body dispose of them. However, intravenous chelation is expensive and has not been proven effective. If the previous steps are only partially effective, I recommend using herbs that can chelate. Although no studies have been done on these herbs, they are generally not harmful, so they’re worth a try. Malic acid (800mg to 1200mg daily) is particularly useful for removing aluminum from the body.
Cilantro is excellent for cleaning all heavy metals out of the blood. Use the following recipe: blend one cup of fresh cilantro with six tablespoons of olive oil until the cilantro is completely chopped. Add one clove of garlic, one-half cup of nuts (cashews or almonds are the best), and two tablespoons of lemon juice. Blend these into a paste (which will be lumpy), adding hot water if necessary. Take two to three teaspoons per day for two to three weeks, every few months. If you make large amounts, you can freeze the mixture for later use. You should see benefits within two to three weeks.