What
is Angina Pectoris?
Angina
Pectoris is a clinical syndrome rather than a disease. This denotes
a discomfort due to transient myocardial ischemia (deficiency of blood
in a part). Almost every adult faces this problem sometime in his
lifetime. It's not the same as a heart attack, but because of the
severity of pain, it often seems like one. When one experiences this
anginal pain he becomes very conscious, frightened and always misconceives
it with Myocardial Infraction (Heart attack).
Angina
is one of the first signs of serious heart disease. The same disease,
'Atherosclerosis' - causes this, the deposits of fatty cholesterol
substances in the walls of arteries that cause blockage or plagues.
Most heart attacks occur because of a clot, which forms at the site
of a plague and suddenly obstructs a coronary artery. When you take
steps to prevent angina pectoris, you are also taking steps to prevent
heart attacks.
Don't
expect any warning that will enable you to prevent the disease. You
don't have then time to change your way of living. You have to follow
these measures that will protect you from Angina.
What
causes Angina?
Let’s
first know, how is your heart is supplied by blood. You have two main
coronary arteries, the right and the left. These start at the beginning
of the aorta (The beginning of arterial system). As oxygen contained
(oxygenated) blood is pumped out of your heart, these first branches
from the aorta are filled with this oxygenated blood to supply your
working heart muscle.
Your
left coronary artery quickly divides into two main branches and supplies
front and left portion of your heart, while right coronary artery
mostly supplies backside of your heart. These three main arteries
branch continuously, and their smallest branches connect together
to form a network of arteries.
These
smallest arteries can become functionally closed, in inactive individuals.
When you exercise, they open to help in increasing the blood flow
to your heart. Those open connections also help to provide subway
around obstructed arteries called as “collateral’s”.
That helps to prevent angina pectoris and heart attacks. The most
common reason the blood flow through the coronary arteries cannot
be raised is because of fatty cholesterol deposits called ‘Plaques’
that obstruct the arterial passage. Thus whenever a major coronary
artery is narrowed too much it unable to increase blood flow through
it when heart needs more oxygen, even obstructs normal blood flow.
The blood platelets start the formation of blood clots and aggregates
at spots where plaque has formed. They release substances that cause
the coronary artery to go into spasm and reduce circulation, which
causes angina.
Signs
and Symptoms of Angina
Typical
anginal pain's sight is most often over middle or lower breastbone,
at times in epigastrium. Sometimes discomfort is located only in left
shoulder or left upper arm, occasionally in lower jaw or in interscapular
area.
Character
- Vice like constriction or choking. Sometimes feels pressure like
weight on their chest or burning pain, rarely mere weakness of one
or both arms. An important characteristic is its constancy, the pain
being steady while it lasts.
Duration
- One of the most important characteristics of the discomfort is its
duration. Usually lasts for one to four minutes may force patient
to stop walking.
Radiation
- May spread to left or right arm or both, neck or jaw. Sometimes
pain starts in the wrists, upper arms or face and then spreads to
the chest.
Provocation
- Occurs with exertion like walking against the wind, or up climb
cold weather. The combination of walking in the cold is apt to cause
anginal pain. Hurrying after meals or unaccustomed exercise, due to
excitement, anger, fear. In advanced cases pain is aggravates by lying
down, violent dreams.
Relief
- With sublingual nitroglycerine (temporary).
Other
symptoms:
• Choking sensation in throat or feeling of impending doom.
• Belching or passage of flatus or increased urination after
an attack.
• Dizziness, faintness.
• If pain is severe sweating and nausea may persists.
• Tachycardia and rise in Blood Pressure.
It
is important to recognize that the heart does not cause all chest
pains. Some of the conditions that can be confused with it are:
•
Painful rib joint (costochondritis)
• Arthritic pain
• Muscular pain
• Pleurisy
• Paricarditis
What
are the preventive measures?
Preventing
the fatty cholesterol deposits and reversing those that have already
occurred is a primary (prior) prevention. Early stages of this disease
can be reversed in many instances. Under the right conditions, the
early plaque can be dissolved; the more mature plaque cannot be eliminated.
There
are many factors that help in forming the plaque, and these are called
risk factors. These are five most important risk factors, Age, sex,
blood pressure, cholesterol and smoking. You can’t do anything
about age and sex, but you can do a lot about the other risk factors
and the many others who affect them such as diet and exercise.
One
who is learned about the cause of plaque, ways to prevent it, and
importantly, applying those ways, it is possible that age and even
sex will not be considered such an important risk factor.
Sex-
In general, heart attacks occur in women about ten years later than
they do in men. Women become much more susceptible to heart attacks
after they go through the menopause.
Cholesterol
- is an important factor in causing coronary artery disease as much
of the plague that forms is from cholesterol. Among all cholesterol,
the LDL cholesterol is the one who most likely to cause fatty cholesterol
deposits and hence called as “bad - cholesterol”. The
HDL cholesterol, removes cholesterol from deposits that occur in your
arteries, having just the opposite effect of LDL and that is why it
is called " good cholesterol".
Blood -Pressure - High Blood pressure is one of the main causes for
fatty cholesterol deposits in the coronary arteries. As a result,
it is a common factor in causing angina pectoris and heart attacks
from coronary insufficiency. High Blood pressure alone increases the
risk of a heart attack, but when a person also has a high total cholesterol
level, the risk is greatly increased.
High pressure causes the arterial wall to thicken and more deposits
will occur. The muscular layer enlarges in response to several complex
mechanisms that cause muscle growth. It causes the left ventricle
to work harder and to enlarge. The enlarged heart muscle works harder
needs a greater blood flow to supply it with more oxygen. At the same
time, the coronary arteries may be affected, with enlarged thickened
walls and fatty cholesterol deposits. That may limit how much increase
in blood flow through the arteries can be obtained. As a result, the
heart muscle may be weakened. The lower your blood pressure, the less
likely you are to have coronary artery disease.
Smoking
- The more you smoke, the greater is the risk, but even smoking a
few cigarettes can increase your risk of a heart attack. Even smoking
a single cigarette can cause the platelets (The tiny cells that start
the formation of a blood clot) in your blood stream to clump. This
also causes coronary spasm (due to this clump), which releases some
substances that causes spasm.
What
should I do to prevent it?
Get
yourself acquainted with following preventive measure:
• Any effective measure that helps to improve cholesterol levels
can be a factor in preventing progression of fatty cholesterol deposits
that is a root cause of all coronary diseases or reversing the early
ones.
• For the more ideal situation, you probably should have total
cholesterol below 200 and HDL cholesterol at 50 or above. That does
not mean you need to take some drastic measures to achieve these ideal
goals, particularly in terms of taking medicines, but you can do this
with your lifestyle, that will significantly decrease your risk of
having a chest pains or heart attacks.
Take
diet low in cholesterol, restrict the total dietary fat consumption
and saturated fat's, limits your calorie intake sufficiently to prevent
or eliminate excess body fat.
•
Omit oily / fried foods in your diet, adopt oil free kitchen techniques
like roasting, baking etc. As one of the most important risk factors
is obesity. Try to minimize your weight if you are obese. Even if
you are having controlled weight, loosing some fat layers will help
you.
Obese
individual who did not have abnormal cholesterol levels, high blood
pressure or abnormal blood glucose must not ignore his over weight.
•
Control your blood glucose level.
• A low fat vegetarian diet is rich in vitamin A, C, and E,
which are antioxidants in property that have been found to help control
or prevent angina.
• Go for a vegetarian diet as they are devoid of excess fat.
If you still want to eat meat, fish or poultry you should limit it.
If your diet consists mainly of vegetables, fruits and whole grains,
then you're getting all the nutrients you need.
• If you belong to these families that have heart attacks early
in life are much more prone to coronary heart diseases. So you must
take extra precautions to control risk factors to delay the onset
of disease.
• Stop smoking as this also increases heart rate which increases
the heart's oxygen demand.
• Heavy use of alcohol can damage the heart muscles and is often
associated with high blood pressure. So minimize or stop alcohol consumption
as sometimes-anesthetic effect of it prevents original pain which
blocks the warning sign that is chest pain but still your heart suffers
from inadequate circulation.
• Exercise - Start regular exercising according to your current
level of physical fitness and the state of your health. Exercise helps
you a lot in preventing or eliminating excess body fat; this itself
will lower blood pressure also. This will also open those small connecting
network of arteries within the heart muscle and improves the heart
muscles efficiency in utilizing oxygen. Exercise prevents blood clotting
according to research [Your body produces an enzyme which protects
against the formation of blood clots].
• Tobacco and caffeine are tend to increase blood pressure so
stop them if you are hypertensive or minimize it (coffee).
• As Angina mostly precipitates with anxiety or stress, try
to minimize this by yoga or meditation. The stress increases the work
of the heart and it's need for oxygen.
• Above all, if you experience angina attacks raise the head
of your bed or sit because lying position may aggravate pain. This
posture eases you in aching.
• Exercising in cold or in polluted places (carbon monoxide)
can trigger angina attacks is some people. So try to avoid this.
How
Ayurveda can help?
According
to ayurved, vitiated vata generates all types of pain. Anginal pain
is also of vata origin; vata vitiates mainly due to two reasons, Dhatu-kshaya
and any obstruction in its natural path. So the treatment depends
on these two factors. Whenever first you feel chest pain, rush to
your doctor and as per his advice do necessary pathological, radiological
investigations. If the Angina is confirmed start medications. Assuming
any chest pain to be Angina and starting self-medication is hazardous.
We
will discuss some of formulations, which alleviate Heart pain (Hrut
shool)
Please consult a qualified physician before starting any medications.
1. Paste of Pushkarmool, Sunthi and shathi mixed with alkali water
(ksharodak), ghee and salt alleviates cutting pain in heart.
2. A decoction of Triphala can be used.
3. A decoction of Musta, Haridra, Daruharidra, Vacha, Kushtha, Chitraka,
Katu rohini etc works as emaciating remedy. Thus this may help in
reducing fatty cholesterol deposits and also acts on obesity.
4. Powder of Yavakshara and Yavani mixed with warm water should be
drunk.
5. Decoction of Arjuna bark added with milk (1:4) is to be boiled
with four parts of water, until only milk is remained. This is to
be taken with Sharkara( sugar) .
6. Decoction of Erandmool twak added with Yavakshara is to be taken.
This pacifies hrutshoola (Heart pain).
7. Decoction of Dashmoola, added with Saindhava and yava-kshara helps
you in decreasing weight and also alleviates chest pain.
8. Mruga shringa bhasma with cow's ghee is to be taken it alleviates
pain.
9. Powder of Pushkarmool added with honey is to be taken orally.
Some
commonly used generic formulations are
Hrudayarnava
Rasa (Y.R), Arogya Vardhini Vati, Chandraprabha Vati, Triphala guggulu,
Yogaraj Guggulu, Chyavanprash, Dashmool Kwatha, Mustadi Kashay, Shilajatu
Rasayana etc. which is to be taken under strict medical supervision.
Do's
-
Have Old sali rice, wheat, yava, mudga (green gram), horse gram, cabbage,
gourd, serpent gourd, Alibanam (Tendil), ginger, garlic, Onion, Dry
ginger, Old pumpkin Pomegranate, mango, grapes, lemon, Orange, Honey,
hot water, Cow's ghee, Ajawayn, Safflower oil, Sunflower oil, Regular
exercise- walking, yoga etc.
Dont's
-
Eat Maize. Jawar, Varak, Pot hurbs, bitter gourd, Sago ,Pea, Black
gram, Cow pea, Kidney beans, fish, Aquatic animals meat, Red meat,
Milk, Milk products, Potato, Sweet potato, Coconut, Custard ,apple,
Strawberry, Pineapple, dry fruits (cashew, almond etc), betel nut,
fried food, junk food, tobacco, alcohol etc.
