Causes of Angina
The symptoms of angina are caused by temporary heart ischemia, or reduced blood flow (and thus oxygen) to the heart muscle. Angina symptoms are often induced by stress or physical exertion, during which the heart rate naturally increases, demanding more blood. Reduced blood flow may be caused by a heart muscle spasm or a momentary blockage of the blood vessels in the heart. If there is cholesterol buildup in the coronary artery delivering blood to the heart, this narrowing could also lead to insufficient blood flow. If the heart's demand for blood and oxygen is not met, the patient will experience the chest pains associated with angina.
As a symptom of heart disease, angina can be caused or compounded by any conditions that predispose a person to heart problems. High cholesterol, high blood pressure, and diabetes can put a person at serious risk for angina. Cigarette smoking, obesity, and living a sedentary lifestyle can also increase the likelihood of developing angina. Those with a family history of heart disease may also be more prone to angina attacks.
Conventional Treatment for Angina
Conventional treatments of angina are designed to reduce the discomforts caused by the symptoms and, if possible, halt the progress of heart disease. Cases of stable angina, in which the patient experiences symptoms exclusively and predictably with exertion or stress, may go untreated. When an angina attack occurs, the patient is encouraged to sit down, relax, and steady their breathing to control their heart rate. Because stable angina is often due to cholesterol narrowing the blood vessels, it is strongly recommended that patients work with their doctors to help identify and reduce their risk factors. They may, for example, work to improve their heart health by lowering their cholesterol and adding gentle exercise to their lifestyle.
Aspirin is sometimes prescribed for stable angina, as it reduces platelet aggregation and blood clots to facilitate blood flow. Blood thinners such as heparin, warfarin, and clopidogrel may also be prescribed to enhance blood flow. Beta-blockers, which decrease heart rate and blood pressure, can potentially alleviate the symptoms of angina by calming the heart muscle. If narrowing of the arteries is causing the ischemia, calcium channel blockers may be taken for vasodilation, relaxing and widening the arteries for more efficient blood flow. Nitroglycerin, or glycerol trinitrate (GTN), is another popular vasodilator that has been prescribed for angina, high blood pressure, and headaches since the 1850's. More recently developed angina treatments include Angiotensin Conversion Enzyme (ACE) inhibitors and Ranolazine, drugs that alter physiological calcium and sodium levels respectively, both of which can influence heart ischemia. The numerous cholesterol-reducing medications on the market may also be considered to help reduce artery blockage and minimize angina symptoms.
In some cases, doctors recommend heart surgery for chronic angina sufferers to improve blood flow to the heart. One technique that may be used is angioplasty, during which the doctor inflates a small balloon in the narrowed artery to expand it. After angioplasty, a small metal coil called a stent may be inserted to make sure that the artery remains wide to accommodate blood flow. Although these surgeries pose a risk in themselves, they may significantly reduce the chance of a heart attack, particularly if the patient is experiencing unstable angina. In extreme cases, heart bypass surgery may also be necessary.
Our Angina Treatment
We believe that the long term solution to angina is preventative, helping the patient to develop new habits toward a healthier heart. Your treatment will begin with a personalized cardiology assessment by our holistic cardiologist. In this initial 30 minute meeting, the cardiologist will learn the history of your symptoms and help you identify risk factors that may be contributing to your angina attacks. Laboratory tests to examine blood cholesterol and other physiological issues that may be affecting your heart will also be performed as necessary. Then, together, you will come up with strategies to help you deal with angina attacks and reduce their frequency.
For alleviation of angina symptoms, we prescribe the classic glycerol trinitrate (GTN) treatment. This can be taken orally as a spray, Nitrolingual, which quickly delivers the dose for immediate relief. The spray can be taken while sitting or lying down, just one or two puffs on or under your tongue for quick absorption. Close your mouth, rest, and repeat twice more if the symptoms don't subside. If you're still in pain after several minutes, you may be having a more serious issue and should call an ambulance.
We also offer GTN tablets, Anginine, to be dissolved in the mouth. Again, the GTN is quickly absorbed into the bloodstream through the mouth; swallowing the tablet whole will not correctly deliver the dose. Either a half or quarter tablet should be sufficient to relieve your symptoms, though this dose may be taken twice more if angina symptoms continue. If the symptoms are not reduced after three doses of Anginine, medical attention should be sought immediately.
Nitrate patches are prescribed for slower, long term release of GTN as a preventive measure for angina attacks. They can be applied each day or just before activities that induce angina attacks as recommended by your cardiologist. The patch should be applied to a clean, smooth area of skin on the body trunk, upper arm, or leg, and should be adhered to a different place each day.
Other drugs, including aspirin, cholesterol lowering drugs, or anti-coagulants (blood thinners) may also be considered depending on your case.
In addition to providing temporary relief of your angina symptoms, we are also committed to helping you change your lifestyle to improve the health of your heart. While this can be a daunting prospect, we will work with you to come up with achievable short term and long term goals. These include modifying your diet to include more whole grains, fruits, and vegetables and cut out excess saturated fats and salt. We will help monitor your weight, cholesterol, and blood pressure, and introduce gentle exercise into your routine. In addition to these changes that will enhance your physical health, we'll also help identify sources of emotional stress that may be causing undue pressure on your heart, as stress management is critical to a healthy heart. As your heart recovers and strengthens, you'll be relieved of the symptoms of angina, significantly reduce your risk of advanced heart disease or heart attack, and live a longer, healthier life.
Next Steps:
Poor health can significantly affect your life. Improve your life by changing to good health. Call our patient coordinator at 1-212-679-9667 or click on Request an Appointment to schedule an appointment with one of our doctors for evaluation and testing.
We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.
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Article Last Updated: 06/26/2009