Angina Health Article

Conservative treatment

Artery disease causing angina is addressed initially by controlling existing factors placing the individual at risk. These risk factors include cigarette smoking, high blood pressure, high cholesterol levels, and obesity. Angina is often controlled by medication, most commonly with nitroglycerin. This drug relieves symptoms of angina by increasing the diameter of the blood vessels carrying blood to the heart muscle. Nitroglycerin is taken whenever discomfort occurs or is expected. It may be taken by mouth by placing the tablet under the tongue or transdermally by placing a medicated patch directly on the skin. In addition, beta blockers or calcium channel blockers may be prescribed to also decrease the demand on the heart by decreasing the rate and workload of the heart.

Surgical treatment

When conservative treatments are not effective in the reduction of angina pain and the risk of heart attack remains high, physicians may recommend angioplasty or surgery. Coronary artery bypass surgery is an operation in which a blood vessel (often a long vein surgically removed from the leg) is grafted onto the blocked artery to bypass the blocked portion. This newly formed pathway allows blood to flow adequately to the heart muscle.

Another procedure used to improve blood flow to the heart is balloon angioplasty. In this procedure, the physician inserts a catheter with a tiny balloon at the end into a forearm or groin artery. The catheter is then threaded up into the coronary arteries and the balloon is inflated to open the vessel in narrowed sections. Other techniques using laser and mechanical devices are being developed and applied, also by means of catheters.

Alternative treatment

During an angina episode, relief has been noted by applying massage or kinesiological methods, but these techniques are not standard recommendations by physicians. For example, one technique places the palm and fingers of either hand on the forehead while simultaneously firmly massaging the sternum (breast bone) up and down its entire length using the other hand. This is followed by additional massaging by the fingertip and thumb next to the sternum, on each side.

Once the angina has subsided, the cause should be determined and treated. Atherosclerosis, a major associated cause, requires diet and lifestyle adjustments, primarily including regular exercise, reduction of dietary sugar and saturated fats, and increase of dietary fiber. Both conventional and alternative medicine agree that increasing exercise and improving diet are important steps to reduce high cholesterol levels. Alternative medicine has proposed specific cholesterol-lowering treatments, with several gaining the attention and interest of the public. One of the most recent popular treatments is garlic (Allium sativum). Some studies have shown that adequate dosages of garlic can reduce total cholesterol by about 10%, LDL (bad) cholesterol by 15%, and raise HDL (good) cholesterol by 10%. Other studies have not shown significant benefit. Although its effect on cholesterol is not as great as that achieved by medications, garlic may possibly be of benefit in relatively mild cases of high cholesterol, without causing the side effects associated with cholesterol-reducing drugs. Other herbal remedies that may help lower cholesterol include alfalfa (Medicago sativa), fenugreek (Trigonella foenum-graecum), Asian ginseng (Panax ginseng), and tumeric (Curcuma longa).

Antioxidants, including vitamin A (beta carotene), vitamin C, vitamin E, and selenium, can limit the oxidative damage to the walls of blood vessels that may be a precursor of atherosclerotic plaque formation.

Prognosis

The prognosis for a patient with angina depends on its origin, type, severity, and the general health of the individual. A person who has angina has the best prognosis if he or she seeks prompt medical attention and learns the pattern of his or her angina, such as what causes the attacks, what they feel like, how long episodes usually last, and whether medication relieves the attacks. If patterns of the symptoms change significantly, or if symptoms resemble those of a heart attack, medical help should be sought immediately.

Prevention

In most cases, the best prevention involves changing one's habits to avoid bringing on attacks of angina. If blood pressure medication has been prescribed, compliance is a necessity and should be a priority as well. Many healthcare professionals—including physicians, dietitians, and nurses—can provide valuable advice on proper diet, weight control, blood cholesterol levels, and blood pressure. These professionals also offer suggestions about current treatments and information to help stop smoking. In general, the majority of those with angina adjust their lives to minimize episodes of angina, by taking necessary precautions and using medications if recommended and necessary. Coronary artery disease is the underlying problem that should be addressed.

BOOKS

Banasik, Jacquelyn L. "Alterations in Cardiac Function." In Perspectives on Pathophysiology, ed. Lee-Ellen C. Copstead. Philadelphia: W. B. Saunders Co., 1994.

Chandrasoma, Parakrama, and Clive R. Taylor. Concise Pathology. East Norwalk, CT: Appleton & Lange, 1991.