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The Pain of Angina Pectoris

Angina Pectoris is a sensation of discomfort in the chest and adjoining areas caused by an inadequate supply of oxygen to the heart muscle. The typical patient is male, in his fifties or early sixties. Approximately 80 percent are men. About 90 percent of cases of Angina are due to coronary atherosclerosis (thickening of the walls of the blood vessels, with narrowing of the opening through which the blood flows). Often at least one of the three major coronary arteries are closed down 80 percent before Angina develops, but in most cases more than one of the three major arteries are involved.

Patients do not describe their discomfort as pain, but rather as a pressure, constriction, smothering, heaviness, choking or squeezing sensation, or even indigestion.

The pain of Angina is generally located in the mid- or upper third of the sternum, but it is frequently noted in the lower sternum, one of both sides of the chest (most commonly the left), the arms (generally the left), and into the neck and jaw, or even the teeth. The pain maybe mild or severe, and is often controlled by slowing down or stopping one’s activity.

Physical exercise is the most common factor provoking angina, and patients often become aware of angina for the first time when walking up a hill, or in a hurry. Pain is more likely to occur after a meal, or in a cold weather. Some people have angina only in the cold months, with complete clearing during warm weather. Activity following meals, particularly heavy meals, is likely to produce symptoms and some sedentary individuals have angina only after meals.

Intense emotion is likely to produce angina. Anger, anxiety, worry, hurry, sexual activity, public speaking, car driving, and watching competitive sports are all known to be likely to produce angina. Many patients report angina immediately after going to bed (maybe because of cold sheets), maybe awakened by it during the night, particularly following nightmares.

Symptoms seem to vary with the time of day, more than from day to day. Activities such as combing the hair, which requires the patient to lift his hands to or above head level, may produce symptoms, while more strenuous activity not requiring elevation of the arms produces none. In the early morning, symptoms are common, and the patient may not be able to shave and prepare for work without stopping, but later in the day may perform moderately heavy labor without discomfort.

Tasks which are routine, which the patient has done for years, may cause no problem, with unfamiliar tasks requiring comparable effort producing symptoms.

The discomfort of angina generally lasts only two or three minutes. If induced by physical activity it diminishes with cessation or slowing of activity; when produced by emotions it subsides more slowly and may last 5 to 15 minutes.

TREATMENT

  • A program of gradually increasing exercise should be encouraged. Patients should begin by exercising to tolerance daily, gradually increasing the amount of exercise as tolerated. When symptoms appear, slow down but do not stop activity. If pain does not diminish or subside, stop until it does.
  • Smoking induces angina in some people and should be avoided. Ten heavy smokers with typical symptoms of angina were exercised until they manifested the first symptoms of angina. Each one performed the test four times while in a non smoking state, again four times after smoking. All of the patients developed angina sooner if they had smoked prior to exercise. The average shortening of the exercise period after smoking was 24 percent.
  • Patients should be careful to keep properly clothed so as not to become chilled. Exposure to cold weather, particularly cold wind on the face, may produce symptoms.
  • Cold drinks may produce symptoms and should be avoided.
  • Begin a weight reduction program if overweight.
  • Use small meals which are easily digested. Never overeat.
  • Eliminate all free fats (oils or grease added to foods, margarine or mayonnaise) from the diet. Fourteen patients were given a fatty meal and six of them suffered a total of fourteen attacks of angina while at rest during a period of three to five hours after the meal. It was noted that the blood fats a were at their peak.
  • Angina at night maybe relieved by elevating the head of the bed. Eight of ten patients in a study group had no angina pain at all during the test period.
  • Use a diet free of animal products (vegan diet). A group of four patients were placed on a carefully controlled diet. The first patient had such a severe angina he had to stop every nine or ten paces while walking. He was placed on the vegan diet in February, and in August of that year climbed mountains with no angina pain. Patient Number Two had severe angina after walking for five minutes. On the diet ha had improvement, and was doing gardening and fairly heavy work without pain, with a normal ECG. After nine months on the diet he gave it up and could not be persuaded to continue. Angina returned with the addition of animal products to his diet. The third patient, after three years on the vegan diet, could climb 2,000 feet up a steep mountain without pain or shortness of breath. The fourth patient, after three to four months on a vegan diet could do heavy work without angina.


Health | Cardiovascular


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