Friday, July 14, 2017

Holistic Approaches to Angina

Anyone who has angina should be under a doctor's care. And just about anyone who has stable angina should consider a therapy called EECP, for which you need a doctor's referral, But there are things you can do to improve the results of medication, percutaneous coronary intervention, and exercise. Just be sure to be willing to discuss anything you do with your cardiologist.

Angina is a muscle cramp in the heart. About 10 percent of cases of angina involve Prinzmetal’s variant angina, a condition in which the same physiological changes that trigger the cerebral artery spasms that cause migraine headaches trigger coronary artery spasms that cause angina. The overwhelming majority of cases of angina, however, result from coronary artery disease (CAD).
   
In CAD, cholesterol plaques narrow arteries so that they cannot transport as much oxygenated blood. During exercise, emotional excitement, or after a heavy meal, the heart pumps faster and harder. Narrowed arteries cannot bring the heart the oxygen it needs, and there is an angina attack. Sweating, shortness of breath, and intense chest pain, usually radiating into the left arm or neck, are the hallmarks of an angina attack.       
         
The most common form of angina is called “stable” angina. In stable angina, repeated attacks occur after similar events, such as overexertion, overeating, or stress. In this form of angina, attacks gradually get worse over time. 

The more serious “unstable” angina may appear suddenly or occur frequently or without apparent cause. Unstable angina is far more likely to lead to heart attack. A third kind of angina known as Prinzmetal’s variant angina is essentially a migraine of the coronary artery. Nerve impulses cause the muscles lining the coronary arteries to tighten and shut off circulation to the heart. People who have Prinzmetal’s variant angina typically have “clean” arteries but circulatory problems in microscopic blood vessels supplying the heart.     
  
An angina attack is not a heart attack. Angina is a signal that some of the heart muscle is not getting enough oxygen temporarily. This pain does not mean that heart muscle is suffering permanent damage. In heart attack, blood flow to part of the heart is permanently cut off. The pain is more severe and, unlike angina, does not go away with rest. Also unlike angina, heart attack may be accompanied by indigestion, nausea, sweating, and general weakness. If you have angina, you should pay attention to the pattern of your attacks—what they feel like, what triggers them, and how long they last—so that you will know to seek emergency medical care should experience a different pattern of pain that could be caused by a heart attack. 

What can you do about angina?
You are sure to get lots of advice from your doctor and your doctor’s staff about diets. The truth is, different people need different diets. People with angina need to follow the diet that corrects their underlying condition: a low-fat, low-cholesterol diet for people with angina who have proven occlusion of the coronary arteries (see Atherosclerosis); a hypoallergienic diet for Prinzmetal’s angina (see Migraine); or sugar-restricted diet for those with hypoglycemia (see Hypoglycemia). Angina sufferers who have had a heart attack should try a low-sodium diet (see Congestive Heart Failure).

Certain nutritional supplements also help:
∆             Coenzyme Q10: 150–300 mg daily.
 ∆            L-carnitine: 500 mg 3 times a day. Diabetics with angina can especially benefit from:
 ∆            Pantethine: 300 mg 3 times a day.
People with Prinzmetal’s variant angina can especially benefit from:
∆             Magnesium aspartate or magnesium citrate: 200–400 mg 3 times a day.

If you have stable angina, you will probably benefit from:
∆             Hawthorn in any one of the following forms, 3 times a day:
•             Solid extract (standardized to contain 1.8 percent vitexin-4’-rhamnoside): 100–250 mg.
•             Leaf and flowers as a tea: 1–2 teaspoons (3–5 grams).
•             Fluid extract: 1–2 milliliters (1/2 to 1 teaspoon).

 Angina sufferers whose EKG’s show S-T depression (who do not have Prinzmetal’s variant angina) also benefit from:

 ∆            Arjuna (Terminalia arjuna):
∆             Extract, as directed by dispensing herbalist.
∆             Pushkarmoola (Inula racemosa): Extract, as directed by dispensing herbalist.

Angina is a serious condition that requires conventional medical treatment. Eventually, however, it can be controlled with the help of natural products. The goals of the natural treatment of angina are assisting the flow of blood and providing energy to the heart.     
 
Coenzyme Q10 (CoQ10) is synthesized by every cell in the body to capture electrons released as the mitochondria, the energy-making centers of the cell, release energy by combining sugar with oxygen. A solid, waxlike substance, CoQ10 is made by the same chemical process that makes cholesterol, and, like cholesterol, CoQ10 is especially abundant in the healthy heart. Since the heart muscle makes and uses energy 24 hours a day, it needs a large quantity of CoQ10. Heart tissue biopsies of people with various heart diseases show a 50–75 percent deficiency of CoQ10 compared to normal.

As people age, the heart makes less CoQ10. Certain cholesterol-lowering drugs also reduce the heart’s supply of this vital enzyme. Replacing CoQ10 is important in treating angina.            
In one study, 12 patients with angina were given 150 mg of CoQ10 daily for 4 weeks. Taking CoQ10 reduced the average frequency of angina attacks by 53 percent. CoQ10 treatment also allowed the angina patients to last longer on a treadmill before experiencing chest pain or abnormal EKGs. A review of more than 100 research studies conducted between 1974 and 2000 finds consistent benefit from CoQ10 for angina sufferers.   
     
L-carnitine also increases the heart’s energy supply. L-carnitine carries fatty acids into the mitochondria, where they can be used for fuel. Most of the body’s supply of L-carnitine is made in the kidneys and the liver. Stresses on these organs (such as diabetes or chronic alcohol abuse) diminish the supply of L-carnitine for the heart. When the heart has an inadequate oxygen supply, it quickly uses up its supply of L-carnitine and is then less able to produce energy.   

Administering massive doses of L-carnitine—2,000 mg of L-carnitine for every 100 pounds (45 kilograms) of body weight—after a heart attack has been shown to reduce heart damage. A Japanese study found that taking 900 mg of L-carnitine daily allowed angina patients to last 2.4 minutes longer in their stress tests. An Italian study in which men with angina were given 1,000 mg of L-carnitine daily found they not only could last longer under stress, but they could also work harder, as measured by a bicycle ergometer. Approximately 1 in 30 people will experience nausea, heartburn, or gas when taking L-carnitine, but it is generally very free of side effects. People with seizure disorders, however, should consult with their physicians before taking this supplement.     
          
Pantethine is a vitamin B derivative that helps transport useful fatty acids into cells. It lowers total cholesterol, LDL, and triglycerides, and raises HDL without interfering with the production of L-carnitine. In one study involving diabetics, taking 600 mg of pantethine daily lowered triglyceride levels by 37 percent. Generally, pantethine lowers total cholesterol by 15–25 percent and triglycerides by 25–40 percent. Taking much more than 600 mg per day can increase your susceptibility to sunburn, especially if you take the blood pressure medication lisinopril (Prinivil or Zestril).  
         
Magnesium deficiency plays a major role in spasms of the coronary arteries, the source of chest pain in Prinzmetal’s variant angina. Magnesium also reduces peripheral vascular resistance, shunting blood from the hands and feet to the heart. Noted naturopathic physicians Michael Murray and Joseph Pizzorno recommend magnesium as treatment during a heart attack. They state that magnesium can:

∆            “Improve energy production within the heart,
∆             Dilate the coronary arteries resulting in improved delivery of oxygen to the heart,
∆             Reduce peripheral vascular resistance resulting in reduced demand on the heart,
∆             Inhibit platelets from aggregating and forming blood clots,
∆             Reduce the size of the blockage, and
∆             Improve heart rate and arrythmias.”      

Magnesium is the primary element in milk of magnesia, and magnesium supplements can cause diarrhea. Usually the effect is short term and takes place during the first 2 or 3 days the supplement is taken.  
             
Herbs used to treat angina open circulation. Hawthorn is both extraordinarily safe and extraordinarily effective in treating angina. This herb contains a variety of flavonoids. Some increase blood flow through the coronary arteries. Some increase left ventricular pressure, making each heartbeat stronger. Some accelerate the heart rate—and some decelerate it.

But the most important property of hawthorn is its ability to protect the heart from the effects of oxygen deprivation.                 

Heart cells, like many other tissues, are able to adapt to oxygen deprivation. They shift their energy production from pathways requiring the use of oxygen to pathways requiring the use of fatty acids. However, when their oxygen supply is restored, as it is when an angina attack ends, they are sometimes damaged and sometimes destroyed.              

At the end of an angina attack, the neutrophils of the immune system release a compound known as human neutrophil elastase (HNE), allowing the arteries to stretch back to a more normal size. The process of relaxing the artery, however, releases massive quantities of free radicals that disrupt the cholesterol coats of heart cells and interfere with the action of L-carnitine. At least one of the flavonoid compounds in hawthorn counteracts HNE.  
     
Hawthorn has several other beneficial effects. Animal studies have found that hawthorn stimulates the liver to use LDL cholesterol to make bile salts, cholesterol salts that are flushed out of the liver and into the stool. Other studies with laboratory animals have found that the hawthorn compound monoacetyl-vitexin rhamnoside relaxes the linings of the arteries, permitting greater blood flow, through a complicated chemical process. And at least one animal study suggests that hawthorn can prevent irreversible tissue damage during heart attack.      
   
There are very few precautions for the use of hawthorn. It is almost completely nontoxic. Like many other natural treatments for angina, however, it can cause diarrhea during the first few days you take it.     
   
Arjuna has been used in Ayurvedic medicine for over 2,500 years as a “cardiac tonic.” Ayurvedic physicians offer it as arjunatvagadi (arjuna in water), pardhadyaristam (grapes and arjuna fermented and boiled), arjunaghrtam (arjuna paste), and arjunatvak (arjuna powder). Animal experiments have shown that arjuna slows and strengthens the heartbeat and protects the heart from tissue destruction during oxygen deprivation. In a study of the use of the herb in treating angina, patients given the herb were found to have greater endurance in treadmill tests, without the complication of lowered blood pressure. Over a period of 3 months, 66 percent of stable angina patients and 20 percent of unstable angina patients showed improved EKGs.14          

Arjuna is usually dispensed by a practitioner of Ayurvedic medicine. There have been no reports of side effects from arjuna products given by herbalists or physicians trained in Ayurveda. Dosage varies with the individual preparation.

Pushkarmoola is another Ayurvedic herb that grows in the foothills of the northwestern Himalayas. Traditional South Asian medicine uses pushkarmoola in the treatment of angina with shortness of breath. A small-scale study in India found that pushkarmoola was more effective than nitroglycerin in effecting favorable EKG changes (elevation of the S-T segment) and in relieving chest pain. And a study involving 200 patients found that combining pushkarmoola with the traditional Indian herb guggul (Commiphora mukkul) in treatment for 6 months relieved shortness of breath in 60 percent of angina patients who had shortness of breath as a symptom at the beginning of the study. One in four patients experienced a complete remission of pain and showed a normal EKG by the end of 6 months’ treatment.    
         
Like arjuna, pushkarmoola is also available from practitioners of Ayurveda. There are no reports of side effects from pushkarmoola products given by herbalists or physicians trained in Ayurveda. 

What else helps with angina?

∆             If your doctor has prescribed a nitroglycerin patch, you will benefit from taking 2,000–3,000 mg of L-arginine daily (preferably in 2 or 3 doses of 700–1,000 mg each). Clinical testing has found that the supplement prevents the development of nitrate tolerance, and ensures that the medication keeps working.
∆             Men who use nitroglycerin for angina must never take sildenafil (Viagra). The combination of blood vessel relaxants can be deadly.
∆             While hawthorn and Ayurvedic herbs are the most useful herbs for treating angina, several others are generally useful for dealing with the causes of angina. However, they also interact with medications commonly prescribed for the condition.
•             Bromelain is thought to break up cholesterol plaques in arteries. There is at least some laboratory evidence that bromelain can be absorbed into the linings of red blood cells and protect them from the action of immune cells associated with plaque formation,18 although this is not a major force in the formation of plaques. There are relatively few potential risks in using bromelain, although it should be avoided by people taking warfarin (Coumadin) or clopidogrel (Plavix).
•             Coleus contains compounds that alter cellular chemistry so that arterial muscles relax and platelets do not stick together. It should be avoided, however, by people on medication for high blood pressure, since the combination of coleus and medication can cause orthostatic hypotension (passing out when rising from a seated or supine position) or sensitivity to cold. A typical dose of coleus is 50 mg of capsules that contain 18 percent forskolin, 2 or 3 times a day. 
•                Garlic is scientifically documented to lower total cholesterol and triglycerides, increase HDL (“good”) cholesterol, and prevent the formation of blood clots. In combination with prescription blood thinners—such as Coumadin (warfarin), heparin, Plavix (clopidogrel), Ticlid (ticlopidine), Trental (pentoxifylline)—or aspirin, garlic increases risk of bleeding. Always tell your doctor you are taking garlic if you are prescribed any blood-thinning medication. The standard daily dosage of garlic is any number of capsules that deliver 10 mg of allicin.
•             Ginger lowers cholesterol and reduces the tendency of blood to clot. Like garlic, ginger should be used with caution by people who take Coumadin (warfarin), heparin, Plavix (clopidogrel), Ticlid (ticlopidine), Trental (pentoxifylline), or aspirin. A quarter-inch slice of ginger root or 250 mg of ginger extract in capsules is an appropriate daily dose.

•             Khella (Ammi visnaga), another herb used in Ayurvedic medicine, relaxes and dilates coronary arteries. It improves exercise tolerance and stabilizes heart rhythm. Taken with the common prescription drug lisinopril (Prinivil or Zestril), however, khella greatly increases sensitivity to sunburn. Take capsules of 250–300 mg of the herb standardized to contain 12 percent khellin daily. 

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