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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.
Causes & Development
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.
Signs & Symptoms
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.
Diagnosis & Tests
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.
Complications; Seek medical attention if
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.
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Signs, symptoms & indicators of Angina:
Conditions that suggest Angina:
Risk factors for Angina:
Angina can lead to:
Recommendations and treatments for Angina: | | | | | Amino Acid / Protein |  Acetyl-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. |
 L-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.1199-203] |
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Botanical |
Hawthorn Berry Extract
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. |
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Diet |
Alcohol Avoidance
Caffeine/Coffee Avoidance
Therapeutic Fasting |
Digestion |
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.139-51] |
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Habits |
 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. |
Tobacco Avoidance |
Mineral |
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. |
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Nutrient |
CoQ10 (Ubiquinone)| | 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. |
TMG (Tri-methyl-glycine)
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. |
Meyer's Cocktail |
Psychological |
Stress Management| | Stress should be decreased by using stress management techniques such as progressive relaxation or guided imagery. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Weakly counter-indicative |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Aerobic (Aerobically)
Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
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. Often triggered by exertion. Angina Vasomotoria: Like the previous, but less dangerous and more frequently caused by purely neurologic stimulus. The pain is more spasmodic and there is usually little actual blood vessel blockage.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
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.
Carnitine
A compound found in skeletal and cardiac muscle and certain other tissues that functions as a carrier of fatty acids across the membranes of the mitochondria. Carnitine has been used therapeutically in treating angina and certain deficiency diseases.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Electrocardiogram (ECG, EKG)
A test that shows a tracing of the electrical conduction of the heart.
Fibrinolytic
Fibrinolytic activity: Clot removal.
Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
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. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Orotate
An oratic acid salt (nucleic acid); an effective molecule for transporting minerals through cellular membranes. Functions as an essential part of every living cell.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Platelet Aggregation
Platelets are the small, rather uniform fragments of large bone marrow cells that aid the blood in coagulation, hemostasis, inflammation, and thrombus formation. Mild subclotting and sticking is a common early condition that can lead to thrombosis, atherosclerosis, and strokes, and can be helped by an aspirin a day, better fat digestion, and Ceanothus.
Sublingual (Sublingually)
Situated or administered under the tongue, for example sublingual glands or sublingual tablets.
Last updated: Feb 07, 2010
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