Angina Lyndhurst NJ

Discomfort in the chest is likely the most frequent complaint for which people seek medical attention. Chest discomfort can result from numerous things including cramping and soreness in the muscles of the rib cage, "heartburn" or other concerns associated with the upper region of the digestive tract, conditions involving the lungs such as a collapsed lung or even potentially life-threatening conditions involving the heart such as a heart-attack.

Angina, also known as angina pectoris, is a condition that can cause chest pain, ranging from mild to quite severe. Angina occurs when not enough oxygen is able to reach the heart muscle, usually due to a decrease in blood flow. Numerous conditions can affect the blood flow to the heart and thus the amount of oxygen reaching the heart muscle. These conditions include coronary artery disease, coronary artery spasm, irregular rhythms of the heart, infections, anemia and even a heart attack can cause angina to occur.

Generally, angina occurs when extra stress is placed on the heart such as during physical exercise or even at times of stress, anxiety and depression.(1) This is known as stable angina and is generally due to the presence of coronary artery disease. Unstable angina can occur at rest and at other unpredictable times such as in the middle of the night. Unstable angina can also be described as frequent and severe chest discomfort in patients that have not experienced chest discomfort previously or increased frequency, severity and worsening of angina in people diagnosed with stable angina. A rare third type of angina is referred to as variant angina, which can occur during exertion or while at rest generally resulting from a spasm in a coronary artery.(2)

American Heart Association, Biostatistical Fact Sheet, 2003.

• 13,200,000 victims of angina (chest pain due to coronary heart disease), heart attack and other forms of coronary heart disease are still living (7,200,000 males and 6,000,000 females).
• Estimates are that 6,500,000 people in the United States suffer from angina.
• An estimated 400,000 new cases of angina occur each year. (Framingham Heart Study, National Heart, Lung, and Blood Institute)
• The estimated age-adjusted (2000 standard) prevalence of angina is greater in women than in men. Angina rates in women age 20 and older were 3.5 percent for non-Hispanic white women, 4.7 percent for non-Hispanic black women and 2.2 percent for Mexican-American women. Rates for men in these three groups were 4.5, 3.1 and 2.4 percent, respectively.
• In 2003, 63,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of angina pectoris. About 51 percent were age 65 and older.
• About 36,000 males diagnosed with angina pectoris were discharged from short-stay hospitals in 1998.
• 49,000 females diagnosed with angina were discharged from short-stay hospitals in 1998.

Occasional chest pain should be evaluated by a health care provider. Medical history and physical exam involving extensive evaluation of pulse, blood pressure, the heart and lungs among other things should be performed. An electrocardiogram (ECG or EKG) evaluating the rhythms of your heart and possibly an exercise stress test for your heart may be ordered. Other tests and procedures are available for use in the cases of more severe coronary artery disease.(4) Significant and severe chest pain needs to be immediately evaluated in an emergency room so that you can be properly evaluated for the possibility of a heart attack. All of these tests are used to help the physicians determine the cause for the angina pain and to help determine the course of treatment.(5)

• Chest discomfort described as dull pressure, heaviness, squeezing or smothering, can include sharp pain
• Sweating
• Shortness of breath
• Nausea

Nitrates are widely used throughout coronary artery disease, not only in angina but also in heart attacks and heart failure. These drugs work by dilating blood vessels, thus decreasing oxygen requirements. One of the most useful nitrates for angina is sublingual nitroglycerin. This small tablet is placed under the tongue at the first sign of an angina attack. It is quickly absorbed and generally provides relief of the chest discomfort. Occasionally, a second or third dose may be necessary. One problem with nitrates is that patients can easily develop a tolerance to the medication, thus causing it to not work as well. Longer acting nitrates, such as topical creams and patches as well as capsules that can be swallowed are also available for use.(6)

Beta-blockers are another class of medications that have been shown to be effective in patients with stable angina. These medications decrease oxygen demand of the heart by decreasing the heart rate and the force of contraction. Another class of drugs known as calcium channel blockers are beneficial for patients with stable angina. They relax blood vessels decreasing the oxygen demand of the heart. Some calcium channel blockers may help slow the heart rate as well. There are three groups of calcium channel blockers and some are not appropriate for people with other types of heart disease.(7) Talk to your healthcare provider about which medications are right for you.

Patients with unstable angina pectoris, in addition to the medications listed above, may require additional therapy due to other complications of their disease state. Antiplatelet therapy, including aspirin, ticlopidine, clopidogrel and glycoprotein IIb/IIIa receptor antagonists, may be warranted. Antithrombin therapy could also be necessary. This type of therapy includes heparin, low-molecular weight heparins and warfarin. Thrombolytic therapy is another possibility in people with unstable angina.(8) Depending on the disease state causing angina and the severity of it, other treatments including surgical procedures may also be necessary.

Adequate magnesium may be associated with reduced incidence of specific types of angina.(15) Research indicates that magnesium may not be successful as a treatment for variant angina.(16) Adequate levels of magnesium are also associated with a reduction in cardiac spasms, and arrhythmias, and magnesium has relaxing and antispasmodic effect on the blood vessels. On the other hand, magnesium deficiency is associated with increased incidence of atherosclerosis, hypertension, strokes, and heart attacks. It is now recognized that many heart attacks happen to individuals with relatively healthy hearts but who are deficient in magnesium.(17)

CoQ10 has been recognized as an effective part of a treatment plan for angina. CoQ10 has been studied extensively in regard to treatment, efficacy, dosage and areas of prevention.(18) In one double-blind study, patients with severe congestive heart failure who were given 150 mg/day of CoQ10 had a 38% decrease in hospitalizations due to worsening of heart failure compared to the control group. At the same time, episodes of pulmonary edema decreased by 60% and angina episodes decreased by 53%.(19) In another study it was shown that the symptoms of cardiovascular disease got progressively worse as CoQ10 levels declined. Treatment with 100 mg of coenzyme Q10 daily resulted in both subjective and objective improvement in 69% of patients with cardiomyopathy and 43% of patients with ischemic heart disease.(20)

Several studies have documented the fact that supplementation with folic acid, vitamin B6, and vitamin B12 can effectively lower homocysteine levels. There are wide variations in the dosages of these B-vitamins used in different studies. It is now recognized that even moderate elevations of homocysteine represent a strong independent risk to cardiovascular disease.

Not all vitamin E studies support the benefits to the cardiovascular system. A study followed over 9,000 people for 4.5 years who took vitamin E or placebo and ramipril, a prescription medication, or placebo. This study tracked many different types of cardiovascular conditions. One of these conditions was unstable angina. Though this angina is different than the angina mentioned in the previous studies, vitamin E had no apparent effect on any of these cardiovascular conditions.(38)

A recent study reported no effect of garlic oil on serum lipids.(51) However, the product used was garlic oil, which is processed and heated garlic. The impact of processing is an important fact to keep in mind when using garlic supplements. Changes can occur in the active constituents when exposed to cooking or other processing which can render the garlic product virtually ineffective. Cooking is known to denature proteins and therefore may inactivate the enzyme (allinase) that is necessary in converting alliin into allicin, the major bio-active constituent in garlic.

One of the most important things a person can do is to stop smoking. Though stopping may not improve your angina symptoms, studies have shown lower death rates in people with ischemic heart disease.(58),(59),(60) Most importantly, before making any changes to your diet and lifestyle, talk to your healthcare provider first to determine what is right for you.