Angina: Overview

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.

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Causes and Development

The primary cause is atherosclerosis, although platelet aggregation, coronary artery spasm, myocardial ischemia, non-vascular mechanisms such as hypoglycemia, and increased metabolic need (as in hyperthyroidism) can also be important considerations.  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 and 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 and 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.

Signs, symptoms & indicators of Angina:

Symptoms - Cardiovascular

Symptoms - Gas-Int - General

Confirmed heartburn

Angina-like symptoms are sometimes due to heartburn, a much less serious condition.

Symptoms - Respiratory

Symptoms - Skeletal

Pain between shoulder blades

The constriction caused by Angina Pectoris induces pain between the shoulder blades.

(Severe) non-specific arm pain

Arm pain due to angina is explained by the concept of referred pain: the same spinal level that receives nerve signals from the heart simultaneously receives sensation from certain areas of skin, without the ability to discriminate the two.  The arms are typical locations for the referred pain, usually the inner left arm.

Conditions that suggest Angina:

Symptoms - Cardiovascular


Risk factors for Angina:


Cigarette Smoke Damage

Smokers have on average 33% more angina attacks than do non-smokers.



Dr. Bantmanghelidj, MD in his book Your Body's Many Cries for Water reports many cases of angina attacks being reduced by drinking adequate water.

Environment / Toxicity

Mercury Toxicity (Amalgam Illness)

Mercury poisoning may be causing chest pain or angina, especially in anyone under age 45.

Symptoms - Cardiovascular

Symptoms - Muscular


Symptoms - Respiratory

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Angina suggests the following may be present:


Coronary Disease / Heart Attack

An episode of angina is not a heart attack.  The pain of angina means that some of the heart muscle is temporarily not getting enough blood.  Angina does, however, mean that there is underlying coronary heart disease.  Although patients with angina are at increased risk of heart attack, an episode of angina is not a signal that a heart attack is about to happen.  When the pattern of angina changes (more frequent or longer-lasting episodes, or occurring without exercise), the risk of heart attack in subsequent days or weeks is much higher.

Angina could instead be:

Organ Health

Sphincter of Oddi Dysfunction

Heart conditions such as angina or ischemia can cause pain that appears to come from the abdomen.

Recommendations for Angina:

Amino Acid / Protein


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.


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]

Botanical / Herbal


When taken in high doses, garlic increases fibrinolytic activity.  This increased fibrinolytic activity inhibits platelet aggregation which contributes to the formation of blood clots.


Digestive Aids


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]


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.



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.


Stress Management

Stress should be decreased by using stress management techniques such as progressive relaxation or guided imagery.


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.


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.


Not recommended
Vitamin B6 (Pyridoxine)

High doses of B6 are not recommended for patients with angina. [Sov Med (7): pp.14-9, 1979 (in Russian)]

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