What is it?

Your heart is always working to pump blood to your entire body. Blood carries oxygen and other things that your body needs in order to do its work. Your heart needs a constant supply of oxygen-rich blood for itself as well. The blood vessels that supply blood to your heart muscle are called coronary (KOHR-oh-nar-ee) arteries. Sometimes one or more of the coronary arteries become narrowed or blocked. This may cause you to feel pain or discomfort in your chest at certain times. This chest pain that comes and goes is called angina (AN-ji-nah).

Angina starts when your heart muscle does not get enough oxygen to do its work. If the heart goes too long without enough oxygen, part of the heart muscle may start to die. This is called a myocardial (meye-oh-KAR-dee-al) infarction (in-FARK-shun), which is also called an "MI" or a "heart attack." Angina can be a warning sign that you may be at risk for a heart attack.

Causes:

• Blockage: The most common cause of angina is fatty deposits (plaque) inside one or more of the coronary arteries. The disease that causes fatty deposits to narrow arteries throughout the body is called atherosclerosis (ath-er-oh-skle-ROH-sis). The fatty deposits alone can cause angina. A blood clot can form on the rough fatty deposits and block the arteries even more. Atherosclerosis is also called "hardening of the arteries."
• Spasm: Sometimes a coronary artery can spasm (suddenly tighten) and cause angina. Most people with coronary artery spasms have fatty deposits as well. Sometimes people have spasms even when they do not have fatty deposits. It is not known what causes coronary artery spasms.
• Other causes: Other medical problems can cause angina or make it worse. For example, heart valve disease, an enlarged heart, or very high blood pressure may cause angina symptoms. Inflammation (swelling), infection, anemia (iron-poor blood), and blood clots can also cause angina. Talk to your caregiver if you have questions about what is causing your angina.

Signs and Symptoms:

Angina is a feeling of pressure, tightness, or pain. This discomfort usually happens in the center of your chest. Angina may also be felt in your neck, jaw, shoulder, back, or as pain or numbness in either arm. You may have discomfort that feels like indigestion (heartburn). You may have shortness of breath, sweating, or feel fear or anxiety before or during an angina attack. Angina may feel different to each person who has it. There are different types of angina:

• Stable Angina: A person with stable angina usually knows what activities will trigger their chest pain. The pain often starts slowly and may last a few seconds to 30 minutes. Stable angina is often triggered by exercise or physical work. It may be triggered by extreme temperatures, heavy meals, or getting upset. Ten minutes of rest or medicine (such as nitroglycerin or "nitro") usually makes stable angina go away.
• Unstable Angina: Unstable angina is chest discomfort that is not expected and may occur at rest. Unstable angina may be more painful and last longer than the pain of stable angina. Some people get unstable angina without ever having stable angina. Stable angina that changes to unstable angina may mean that your heart is getting worse. Unstable angina is serious. If you have an angina attack that is worse or different than usual, you need to be seen in an emergency department right away.
• Prinzmental's or variant angina: This type of angina is caused by a spasm of a coronary artery.
• Microvascular angina: This is angina that occurs without narrowing, blockage, or spasms of the coronary arteries. A problem with tiny blood vessels that supply the heart is thought to cause this kind of angina.
• Atypical angina: Women and people who have diabetes may not have typical chest pain when they have a heart problem. The discomfort may be in an unusual place or there may not be pain at all. With atypical angina, a person may have symptoms, like shortness of breath or nausea as their only sign of a problem.

Wellness Recommendations:

If you smoke, you should quit. Lose weight if you are overweight. Eat a low fat, low salt balanced diet. Daily aspirin can decrease the chance of forming a blood clot. Exercise at least 3 to 4 times a week. Encourage family members to learn how to do CPR.

Medical Care:

• Nitroglycerin is a medicine that opens up the heart arteries if you have stable angina. This may help your heart get more oxygen. It may also lessen the amount of oxygen your heart needs.
• Other heart medicine may lessen your pain and how often you have the pain.
• Medicine may also be used to decrease your cholesterol.
• You may need to be put in the hospital for tests and treatment if you have unstable angina.

HOW TO TREAT YOUR SYMPTOMS:

The treatments discussed below should not take the place of good medical care. Always talk to your caregiver when you have questions or concerns about your angina or how it is treated.

Dietary Measures:

• A vegetarian diet and a diet high in whole grains and fiber can decrease lipids (fats) in the blood.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

• Hawthorn (Crataegus oxyacantha) has been used for heart disease, but has not been studied in people who have angina.
• Khella (Amnii visnaga) may be helpful for angina and has been studied in people.

Supplements:

• Arginine may be helpful for angina and has been studied in people.
• B-complex vitamins have been used, but have not been studied in people who have angina.
• Carnitine has been used, but has not been studied in people who have angina.
• Co-enzyme Q10 (Co Q10) may be helpful for angina and has been studied in people.
• Fish oil (EPA, DHA) has been used, but has not been studied in people who have angina.
• Magnesium has been used.
• Selenium has been used, but has not been studied in people who have angina.
• Vitamin E may be helpful for angina and has been studied in people.

Complementary Therapies:

• Acupuncture may help angina. For more information, read the ACUPUNCTURE document.
• Exercise decreases heart disease risk.
• Meditation and stress reduction techniques may help angina. For more information, read the MEDITATION and the RELAXATION TECHNIQUES documents.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

• You would like medicine to treat angina.
• Your symptoms have not gone away or improved by these self-help measures.
• Tell your caregiver if your angina is worse after exercise.
• Tell your caregiver if you have chest pain after taking your heart medicine.
• You are having chest pain that wakes you from sleep. Do not ignore chest pain.
• You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

The following are signs of a heart attack, which is an EMERGENCY. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital or clinic. Do not drive yourself.

• You have chest pain that happens more often or starts easier with less exertion than usual.
• You have chest pain that lasts longer than 10 to 15 minutes even after you rest.
• You have chest pain that does not go away after taking your nitroglycerin or other anti-chest pain medicine.
• You have chest pain that occurs during exercise and does not go away with rest.
• You feel too dizzy to stand up or you pass out (faint).
• You are sweating, have nausea (upset stomach), or are having trouble breathing.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Blum A, Porat R, Rosenschein U et al: Clinical and inflammatory effects of dietary L-arginine in patients with intractable angina pectoris. Brief Reports 1999; 2(9149):1488-1490.

2. Cacciatore L, Cerio R, Ciarimboli M et al: The therapeutic effect of L-carnitine in patients with exercise-induced stable angina: a controlled study. Drugs Exp Clin Res 1991; 17(4):225-335.

3. Chao DM, Shen LL, Tjen-A-Looi S et al: Naloxone reverses inhibitory effect of electroacupuncture on sympathetic cardiovascular reflex responses. Am J Physiol 1999; 276(6 pt 2):H2127-H2134.

4. Liu S, Stampfer MJ, Hu FB et al: Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. Am J Clin Nutr 1999; 70(3):412-419.

5. Manson JE, Hu FB, Rich-Edwards JW et al: A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341(9):650-658.

6. Miwa K, Miyagi Y, Igawa A et al: Vitamin E deficiency in variant angina. Circulation 1996; 94(1):14-18.

7. Mortensen SA: Perspectives on therapy of cardiovascular diseases with coenzyme Q10 (Ubiquinone). Clin Invest 1993; 71:116-123.

8. Reuter HD: Fifth Phytotherapy Congress in Bonn. Zeitschrift fur Phytotherapie Quart Rev Nat Med Summer 1994; 123-133.

9. Zamarra JW, Schneider RH, Robinson DK et al: Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Am J Cardiol 1996; 77(10):867-870.