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Angina

 

Angina Introduction

Angina pectoris is the occurrence of chest pain resulting from inadequate oxygen delivery to the heart muscle. The decrease of blood supply to the heart may also results in an obstruction of certain blood vessels, known as cardiac ischemia.

This form of angina occurs most often after exercise, but can also be precipitated by emotional stress, a large meal, or cold weather.[1] There are two other forms of angina: Prinzmetal’s, or Variant Angina, and coronary artery spasm induced by magnesium deficiency. For the purpose of this article all information will pertain to “angina pectoris.” :angina-sm.jpg Angina is a result of coronary artery disease. Coronary artery disease is narrowing of the lumen of the vessels that supply blood (and oxygen) to the heart muscle.

Bold TextAs the work load on the heart increases the demand for oxygen in the cells increases. When the lumen is narrowed by greater than 50% there will not be sufficient delivery of oxygen so the muscle cells will become ischemic and the individual will experience pain.

The pain is a result of both the ischemia and building up of metabolites from producing energy without oxygen (anaerobic metabolism). Individuals with coronary artery disease will often have high cholesterol and triglycerides levels, high blood pressure, atherosclerosis, and high fasting blood sugar. Angina can also be caused by diseases that increase the work load on the heart (aortic stenos is, COPD, etc), cocaine overdose, and coronary embolism.[2] The treatment section of this article will focus on angina caused by coronary artery disease.

Angina Symptoms

The pain of angina occurs in episodes that last just a few minutes. Individuals can describe the episode in a range of ways. Most complaints arise from either a vague ache or crushing pain. The pain is usually felt over the breast bone, but may radiate to the left shoulder/arm, jaw, teeth, right arm, and abdomen.

Angina is most often precipitated by physical exertion that increases the work load on the heart. It is worse when the exertion follows a meal and cold weather. It is usually relieved by rest and can always be relieved by sublingual (under the tongue) nitroglycerin.

During the episode, heart rate and blood pressure may increase, there may be an extra heart sound (changes in heart sounds), and palpation of the cardiac border, which may reveal further irregularities.[4] Many individuals will not know of any underlying heart disease until they experience their first episode of angina.

Angina Statistics

  • Angina affects 6.8 million Americans.
  • Each year there is an estimated 400,000 new cases.
  • Angina affects women greater than men in each age and race category.
  • Coronary artery disease is the cause of 1 in 5 deaths each year in the US.
  • There will be an estimated 1.2 million new and recurrent cases of angina and myocardial infarction (heart attack) each year, and 42% will die.[3]

Conventional Treatment for Angina Pectoris

Angina Pectoris is a serious condition and the supervised care of a licensed physician is very important. Conventional treatments of angina pectoris are coronary vasodilators, beta-blockers, and calcium antagonists. One such vasodilator, nitroglycerin, is the most commonly prescribed medication in treating angina pectoris. Nitroglycerin causes the vasodilatation (opening) of the coronary arteries, which results in increased blood flow to the heart muscle; thereby ending the painful episode.

Angina Pectoris Drugs: Individuals with angina who have known underlying coronary artery disease or other cardiovascular disease may be on anti-hypertensive drugs, beta blockers, calcium channel blockers, and anti-lipid drugs.

Alternative treatment should not only focus on conventional medicines, but also on reducing an individual’s risk factors for angina pectoris. Although not appropriate for treating an acute episode of angina, the treatment of the underlying coronary artery disease is equally important.

Supplements for Angina Pectoris

Hawthorne Berry Hawthorne berry (Crataegus) is a cardio-protective herb. The berries are high in flavonoids, which makes it an effective anti-oxidant. It improves energy metabolism for muscles, including the heart muscle. Hawthorne berry is also thought to enhance the contractility (strength of contraction) of the heart, and may assist in lowering both blood pressure and cholesterol. Hawthorne is considered a legitimate dietary supplement for persons suffering from angina pectoris, as it improves oxygen delivery via dilation of the coronary vessels.[5]

Garlic Garlic (Allium sativum) is botanical that can be used to reduce the risk of angina and also the risk of reoccurrence. Garlic does not treat acute episodes of angina, however , it has been shown to positively influence high cholesterol. Elevated cholesterol levels are a precipitating factor for coronary artery disease and angina. In study, garlic has been shown to lower total cholesterol, LDL, and triglycerides by 15%. It also produced an increase in high-density lipoproteins (HDLs) by nearly 10%.[6] Garlic has also been shown to have blood pressure lowering effects, which can be helpful for individuals with angina pectoris.[6] In other studies, garlic extract was equally effective at decreasing atherosclerotic plaque formation.[7]

Khella Khella, Ammi visnaga, is another botanical herb that has been used to treat angina pectoris. Mediterranean physicians have used khella regularly within the past decade to treat spasms of smooth muscle, including cardiac tissue. Its constituents are known to dilate coronary arteries. The main constituent, khellin, is effective at relieving the symptoms of angina and its effects are compared to those of nitroglycerin. It has also been shown to improve exercise tolerance and normalize electro cardio-gram (ECG or EKG) results.

Commiphora mukul Commiphora mukul, myrrh tree, is a botanical medicine that is effective at decreasing total cholesterol, LDL, and triglyceride blood serum levels. It also raises HDLs, or good cholesterol levels. Its physiological actions are comparable with conventional medications for lowering blood lipid count. Commiphora mukul may also combat platelet aggregation and promote the breakdown of fibrin (a component of arterial plaques).

Folic Acid, Vitamin B6, Vitamin B12 Deficiencies in folic acid, vitamin B6 and vitamin B12 have been shown to cause an increase in homocysteine. Increased homocysteine levels promote damage to the lining of arteries, which may lead to atherosclerosis. B-vitamin compounds, like folic acid, B6, and B12, are nutrients that can be used to treat the many underlying factors causing angina pectoris. Repeated studies have indicated that supplementation with folic acid, B6 and B12 effectively reduces homocysteine levels.

Arginine Arginine is a nonessential amino acid synthesized by the body. However, its supplementation is recommended for individuals suffering from angina pectoris. Arginine is a biochemical precursor to nitric oxide. Nitric oxide is the precursor to the “endothelial derived relaxing factor,” which causes vasodilatation of arteries. Nitric oxide is also important for regulation of blood pressure, proper heart muscle function, and regulation of the inflammatory response by heart muscle.[8]

One study found that supplementation with arginine improved symptoms of angina pectoris during attacks. Exercise capacity, as tested by electro cardio-gram, was also improved after arginine supplementation for a period of just three days.[9] Another clinical trial found that supplementation with arginine over longer durations (greater than 3 weeks), improved angina class, systolic blood pressure, and quality of life.[10]

Carnitine Carnitine is an important nutrient for energy production inside the heart muscle cell. It has been shown to effectively transport fatty acids into the mitochondria (energy factories) of cells. A deficiency of carnitine is associated with a buildup of fatty acids outside of mitochondria and an overall decrease in energy production by the cell. Carnitine also enables the heart muscle to better utilize the available oxygen, therefore being protective by improving efficiency when there is limited supply of oxygen. Carnitine is also considered an effective anti-oxidant, decreasing damage caused by oxidative stress on the heart. It also quenches reactive oxygen species, which are known to be a factor for the development of coronary artery disease.

In one particular clinical trial, carnitine supplementation for three months resulted in an increase in duration of exercise and decrease in recovery time after an episode of angina pectoris, when comparing ECG at baseline and the end of the study.[10] Another study found that carnitine protected the heart cells from hypoxia and oxidative damage.[11]

Coenzyme Q10 Coenzyme Q10 is an essential nutrient for energy production inside the mitochondria of heart cells. Because of the heart’s continual pumping action, it needs a continuous production of energy. Individuals with angina pectoris and other heart disease need increased levels of coenzyme Q10.

Studies have shown that CoQ10 supplementation caused a 53% decrease in frequency of angina pectoris episodes in patients with stable angina.[12] Exercise tolerance on treadmill test was also increased in another comparative study concerning patients supplementing with coenzyme Q10. This study also concluded that CoQ10 supplementation was safe, well tolerated, and an effective treatment for angina.[13]

References

[1] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 35-41. Churchill Livingstone New York.

[2] Beers M and Berkow R. 2004. Merck Manual 17th Ed. Chapter 202.

[3] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml October 7, 2004 Heart attack and angina statistics (2001)

[4] Beers M and Berkow R. 2004. Merck Manual 17th Ed. Chapter 202.

[5] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 35-41. Churchill Livingstone New York.

[6] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 35-41. Churchill Livingstone New York.

[7] Wilburn AJ et al. The natural treatment of hypertension. J Clin Hypertens. 2004 May; 6(5):242-248.

[8] Siegal G et al. The effect of garlic on arteriosclerotic nanoplaque formation and size. Phytomedicine 2004 Jan; 11(1): 24-35.

[9] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 60-70. Churchill Livingstone New York.

[10]Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 35-41. Churchill Livingstone New York.

[11] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 60-70. Churchill Livingstone New York.

[12] Appleton J. Arginine: Clinical potential of a semi-essential amino. Altern Med Rev. 2002 Dec; 7(6): 512-522.

[13] Blum A et al. Clinical and inflammatory effects of dietary l-arginine in patients with intractable angina pectoris. Am J Cardiol. 1999; 83: 1488-1490.

[14] Pollishi A et al. Effect of oral l-arginine on blood pressure and symptoms and endothelial function in patients with systemic hypertension, positive exercise tests, and normal coronary arteries. Am J Cardiol. 2004 Apr 1; 93(7): 933-935.

[15] Iyer RN et al. L-carnitine moderately improves the exercise tolerance in chronic stable angina. J Assoc Physicians India 2000 Nov; 48(11): 1050-1052.

[16] Pauly DF and Pepine CJ. Role of carnitine in myocardial infarction. Am J Kidney Dis. 2003 Apr; 41(4 Supp 4): S535-543.

[17] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Pp: 60-70. Churchill Livingstone New York.

[18] Tran MT et al. Role of CoQ10 in chronic heart failure, angina, and hypertension. Pharmacotherapy 2001 Jul; 21(7): 797-806.