Angina

ANGINA, or angina pectoris, is the pain caused by the heart not getting enough oxygen. It produces a sensation of heaviness or pressure in the middle of the chest, with the pain sometimes moving to the left arm, throat or jaw.

The condition that makes such attacks possible is narrowing of the coronary arteries, which carry oxygen-rich blood to the heart. An attack of angina can be brought on by over exercise, a large meal, emotional upset or stress. Little clumps of cholesterol-based substances called plaques, which accumulate inside the artery walls causing them become narrower in a similar way to the grease that builds up in the pipe draining the kitchen sink.

Elevated blood cholesterol is one cause of plaque, but it's not the only one. Current theory suggests that an injury to the inner lining of the artery, called the endothelium, is the initial step for plaque formation.

One common cause is cigarette smoking, and vitamin B6 deficiency is thought to play a part. Other possible factors include malfunctioning immune system; physical injuries; viral, bacterial or chemical attacks, certain drugs, poor diet, and, quite simply the normal chemical processes of ageing. Certain chemical agents can cause blood cells platelets to clump together, which also helps plaque to form.

Angina is a serious condition and should not to be ignored as it can lead to a heart attack. If symptoms begin to occur with more often or with less provocation than usual, it could be a sign of heart disease getting worse and the possibility of a heart attack. If you have any undiagnosed chest pain, you should see a doctor immediately for an examination.

 

THREE SUPPLEMENTS TO INVESTIGATE

People who have diets that are low in certain nutrients will tend to be more prone to heart disease. as well as changing eating habits, it may be worth checking with a nutritionist about supplementing your diet with vitamins and other nutrients. Supplementing the diet with the following three nutrients can help those who experience angina.

• Bromelain. Made from certain enzymes in pineapple, bromelain has anti­inflammatory effects, stops platelets from sticking together, and has been shown in studies to break down arterial plaques and ease angina.
  
  Typical dosage: 250 to 500 milligrams three times per day on an empty stomach.
  
  Caution: bromelain may occasionally cause stomach upset - in the same way as eating too much fresh pineapple can.

• L-carnitine. This is an amino acid involved with energy production at the cellular level. It acts to increase the efficiency of oxygen use within the heart muscle and also lowers cholesterol. Clinical studies have shown, angina patients who took L-carnitine could take more exercise, and when exercising as much as they could, their ECG readings were improved.
  
  Typical dosage: 750 to 1,500 milligrams per day in divided doses.

• Coenzyme Q10. This vitamin-like substance, like L-carnitine,is involved with energy production in the cells. One small study showed that patients with stable angina had their episodes of chest pain reduced by more than half, and increased the time spent on a treadmill before experiencing chest pain by a full minute.
  
  Typical dosage: 150 milligrams per day in divided doses.

Angina is a very serious disease, you must continue to see your family doctor or cardiologist on a regularly. If you are taking medications for angina, then work with an experienced herbalist as drugs for the heart and herbs can interact many potentially dangerous ways. Do not stop taking prescribed medications without expert advice.

The herbal treatments for focus on preventing attacks. If an episode of angina is occurring, take your glyceryl trinitrate (GTN). Herbs can lower blood cholesterol, prevent the clumping of blood platelets, prevent and heal injuries to the endothelium of arteries, shrink plaques, and expand or dilate involved arteries. They can strengthen the heart in general, particularly with herbs that improve energy metabolism within the heart.

DRUG TREATMENT

Nitrates
Under-the-tongue glyceryl trinitrate, or GTN (tablets or spray), isosorbide dinitrate (Angitak, Isordil, Sorbitrate), isosorbide mononitrate (Imdur, Ismo, Monit), glyceryl trinitrate ointment (Percutol).

Function: reduce angina pain by relaxing the smooth muscles in the coronary arteries.

Side effects: headache, slight decrease in blood pressure.

Beta Blockers
Propranolol (Inderal), metoprolol (Lopresor), labetalol (Trandate), others.

Function: decrease the heart's oxygen consumption by reducingthe strength of its contractions, as well as blood pressure and heart rate.

Side effects: heart failure, too-low heart rate, spasms and narrowing of airway passages, decrease in high-density lipoprotein (HDL) cholesterol, memory and concentration problems, depression, erectile dysfunction (impotence), altered sleep, fatigue.

Calcium Channel Blockers
Nifedipine (Adalat, Cardilate MR), diltiazem (Calcicard CR, Dilcardia SR, Tildiem), verapamil (Cordilox, Securon, Univer), others.

Function: inhibit the movement of calcium into cells, dilate coronary vessels and reduce the heart's demand for oxygen.

Side effects: flushing, low blood pressure, dizziness, swelling, headache, heart failure, heart rhythm irregularities.

Other Drugs
Aspirin.
Function: decreases risk of heart attack by preventing platelets from sticking together.
Side effects: heartburn, indigestion, stomach irritation, mild nausea or vomiting.

HERBAL REMEDIES

Garlic (Allium sativum) and Onion (A. cepa)
These are both excellent medicine for the heart. They contain substances that discourage platelets from sticking together and prevent blood clots. They both lower total cholesterol and triglycerides, another type of blood fat, at the same time increasing HDL, the 'good' cholesterol.

Include one garlic clove or half a small onion in your daily diet. They are best used raw or cooked as little as possible so as to preserve their beneficial compounds. Garlic is also available in supplement form.

Typical dosage: standardised capsules that deliver a daily dose of at least 10 milligrams of allicin.

Ginkgo (Ginkgo biloba)
The traditional value of ginkgo in the prevention of angina and the treatment of cardiovascular disease has been confirmed by scientific research. Ginkgo is an antioxidant and helps neutralise harmful molecules called free radicals. It makes heart cells more efficient and increases blood supply to the extremities. It is also a tonic for the blood vessels, gradually improving their overall health, and keeping platelets from sticking together.

Typical dosage: 40 to 80 milligrams of capsules standardised to 24 percent heterosides, three times per day.

Caution: rare cases of gastrointestinal upset, headache and dizziness have been reported.

Hawthorn (Craiaegus spp.)
This is a traditional herb used in treating heart disease. It dilates coronary arteries, increasing blood supply to the heart. It also improves the hearts energy-producing processes, including oxygenation and energy metabolism It decreases lactic acid, the waste product of exertion that causes heart muscle pain.

An antioxidant and anti­inflammatory, it reduces cholesterol. and also helps strengthen artery walls. Products are usually made from either the flowers and leaves or the berries, which are stronger.

Typical dosage: 1 cup of infusion three times per day (simmer 1 teaspoon of dried berries or steep 1 teaspoon of leaves and flowers in 1/4 litre of hot water for 10 to 15 minutes). 1/2 to 1 teaspoon of tincture three times per day.
100 to 250 milligrams of capsules standardised to 20 per cent proanthocyanidins three times per day.

Coleus (Coleus forskohlii)
Coleus works primarily by activating a chemical in the body called cAMP. Among other things, cAMP prevents platelets from sticking together, relaxes arterial muscles and improves heart function.

Typical dosage: 50 milligrams of capsules standardised to 18 per cent forskolin two or three times per day.

Caution: use coleus carefully if your blood pressure is already too low or if you are on medication for your blood pressure. Coleus can also increase the effects of antihistamine drugs.

Khella (Ammi visnaga, syn. Daucus visnaga)
This herb dilates coronary arteries. Several scientific studies have verified its effectiveness in treating angina. It also improves exercise tolerance and normalises heart rhythms in people with angina.

Typical dosage: 250 or 300 milligrams of capsules standardised to 12 per cent khellin per day.

Caution: at higher dosages, nausea, decreased appetite and dizziness may occur. If this happens, reduce your dose.

Ginger (Zingiber officinale)
May help to reduce angina episodes by lowering cholesterol and preventing platelets from sticking together. It works best if eaten fresh and on an empty stomach.

Typical dosage: up to a 6­millimetre slice of an average-size root daily; or 250 milligrams per day of freeze-dried fresh root in capsules.

Caution: ginger may cause upset stomach, especially at higher doses.