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Complete information on Coronary Heart Disease

Herbal Cure for Heart - Complete Pack
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What is Angina pectoris?
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If angina is only a symptom, what diseases does it signify?

How does angina usually present itself? Most people believe it is a pain limited to the left side of the chest and left arm.

What kind of situations may induce classical angina?

Can any other condition cause angina-like symptoms?

How is the diagnosis of angina established?

What are the mainstays of treatment in a patient of effort angina?

What measures should be adopted in everyday life to curb the disease?

What are the medications which come in useful in angina? Are any precautions required?

When does the need for surgery arise?

What is the prognosis for a patient of angina today?

What is Angina pectoris? Top

Much as it may surprise you, angina is not the name of a disease. Rather, it describes a symptom or a collection of symptoms- a clinical syndrome. By itself, the word angina connotes a temporary suffocative attack, which may be associated with discomfort or pain. When this occurs in the pectoral region or the chest, it is named Angina pectoris. Occurring primarily because of the gap in the demand and supply of oxygen to the heart muscles, it is a short-lived sensation of tightness in the chest, provoked usually by some kind of exertion, and relieved by rest.

If angina is only a symptom, what diseases does it signify? Top

Essentially, it is a symptom which occurs in such situations where blood flow to the heart muscles falls short of the requirement. Thus the coronary artery disease is the commonest culprit. But other diseases may also be responsible. A critical narrowing of the heart's aortic valve, syphilitic affection of the great vessel-aorta, and an obscure condition by the name of hypertrophic cardiomyopathy may compromise the coronary blood flow and induce angina.

How does angina usually present itself? Most people believe it is a pain limited to the left side of the chest and left arm. Top

That is not entirely true. There can be considerable variation in the nature and extent of the pain. Yet, classically it is a chest pain brought about by physical exertion, anxiety, or other stimuli, and relieved by rest.

Typically, the pain is situated over the sternum (breast bone) or the middle of the chest. From here, it tends to spread over the chest in a vicelike manner. It may travel to the left and the right (more frequently the left) pectoral region, which is the large muscular region under each nipple. It may continue to spread, upwards into the neck and the shoulders, and down the arms. Yes, the left arm is more frequently affected. From the arm, the pain may go down to the elbow, and still further down the inner side of the forearm, often affecting the fingers and the hand.

Likewise, from the upper chest region, it may spread to the face, involving the cheek and the jaw.
Almost invariably the front part of the chest is involved. But unusually it may be below the chest, in the pit of the stomach (epigastrium area).

Patients suffering from angina often describe their pain as vicelike, constricting, crushing, pressing, or a sensation of a weight on the chest. Characteristically, the pain tends to be remarkably constant while it lasts, which is usually only for a few minutes. There is no shooting, stabbing or pricking sensation, and the pain is not related to the movements of the chest wall that occur during respiration.

The cause of its onset is one or the other precipitating factor, which increases the workload on the heart. As the pain strikes, the patient involuntarily ceases doing what he is engaged in, and tends to rest automatically. The pain reaches its maximum intensity quickly, and from the critical point, it subsides, along with the cessation of activity, and quietly fades away. There may be accompanying breathlessness.

In some patients, in rare cases, the pain may come capriciously, without any obvious precipitation factor. The root of the problem in such cases is different. It lies in sudden, reversible coronary artery spasm. This anginal pain occurs even at rest. It has been named 'Prinzmetal's angina', and at times it is difficult to diagnose.

What kind of situations may induce classical angina? Top

Physical activity is the commonest trigger. It could be in any form-even walking, particularly if it is against a wind, uphill, or on a full stomach. Anxiety and emotional upsets, arguments, situations where tensions mount may also provoke it. In some patients, unpleasant, 'energetic' or action-packed, alarming dreams have also been known to produce attacks.

Can any other condition cause angina-like symptoms? Top

Very few conditions can simulate effort angina, that is, chest pain induced by effort and relieved by rest.

Most pains of gastrointestinal origin, such as due to indigestion, oesophagitis, with or without a hiatus hernia, cannot be effort-related. Even otherwise, the pain in oesophagitis is of a burning nature and is relieved by antacids.

Musculoskeletal pains, particularly those occurring in spondylosis of upper back or neck vertebrae can be sometimes confusing. They are however not specifically effort-related, and are provoked by specific movements, which angina is not. The pain in costochondritis can be quite awful, but is limited to the junction where ribs and the breast bone meet. Further, musculoskeletal pains are not as brief as anginal pain.

Bronchial asthma, when induced by exercise, may also give a sense of tightness in the chest, but it lasts longer than angina and breathlessness is more prominent.

How is the diagnosis of angina established? Top

Largely, on the basis of the patient's history. An electrocardiogram (ECG) may be helpful too, particularly if it is taken during an attack. Otherwise, it may yield nothing, the condi¬tion being normal in most patients at rest between attacks. In such cases, an exercise ECG (Treadmill Test) and a 24-hour continuous monitoring by Holter technique may help diagnosis. Coronary angiography may be necessary in a few cases, particularly in patients with Prinzmetal's angina.

What are the mainstays of treatment in a patient of effort angina? Top

Generally, therapy revolves around measures to reduce risk factors, specific medications, and/ or coronary angioplasty or bypass surgery.

All this needs careful consideration-the extent of disease, the health of the heart, the patient's response to medication, and the patient's age. For this, the patient may require further tests, such as isotope studies and coronary angiography. Angiography is obligatory in all such cases where bypass surgery is being contemplated.

What measures should be adopted in everyday life to curb the disease? Top

The patient must stop smoking. Continued smoking not only increases the rate of progression of CAD, but also makes the drug treatment more difficult by affecting the efficacy of some anti-anginal drugs adversely.

In overweight patients, dieting to standard weight according to one's age, sex, frame, and height is desirable to reduce the load on heart. This requires a diet plan in consultation with a dietitician. In general, easily digestible food, in moderate quantity and low in fat content, is best.
Hypertension, if present, should be corrected by taking precautions and regular medication.
Hyperlipidaemia, that is increased cholesterol and triglyceride levels in the, blood, should be corrected. Dieting to ideal body weight is helpful and sometimes specific medication may be required.
Avoiding alcohol is 'advisable, though an occasional social drink would probably do no harm.

Avoid situations which cause emotional crises and hot temper. This can prove punishing to the health in more than one way, pushing up both the blood pressure and the heart rate. It would be best if the patient could adopt a life of moderation and take adequate time off for relaxation, recreation, and sports.
Patients whose work involves heavy manual activity may have to change their type of work. This they should do without any rancour.
It is best to avoid walking after taking a meal. This can precipitate an attack in patients of angina. If walk you must, take a light meal.
Severe isometric exercise, such as lifting heavy suitcases, moving furniture, pushing cars,- is prohibited. But if your doctor allows, moderate, regular exercise would do good. It helps in the natural process of repair by furthering spontaneous development of collateral vessels to bypass the blocks in the coronaries.

Herbal Cure for Heart - Complete Pack
Total Heart Support	Arjuna	Arjun Tea	Arjun Saar	Kumari Saar	Total Price
					Free Shipping and Handling Worldwide! No Side Effects!
2 Bottles	1 Bottle	1 Pack	4 Bottles	4 Bottles	Free Shipping and Handling Worldwide! No Side Effects!
$47.90	$ 31.00	$ 14.95	$ 75.80	$ 75.80	~~$ 274.55~~
Price after Discount 20%					$ 220.00
Buy This Pack for Just $ 220.00
Free Shipping and Handling Worldwide! No Side Effects!

Click here to buy Individual herbal products for heart care

What are the medications which come in useful in angina? Are any precautions required? Top

A number of anti-anginal medications are in vogue. Each has its own uses and limitations.

The good old nitroglycerine tablets, being marketed as Myovin and Nitromack. Retard, are the cheapest and very effective. Fresh supplies are essential for good results as they go bad quickly on exposure to air, moisture, and sunlight.

A tablet sucked under the tongue or crunched for more rapid effect and retained in the mouth usually helps relieve the pain in about two minutes, and the good effects last for 15 to 30 minutes. The dose may be repeated often, up to two tablets an hour. The product is almost devoid of toxic effects, other than a slight headache.

Apart from aborting an anginal attack, it can act as a prophylactic. A tablet sucked under the tongue before taking up any activity which is expected to cause pain can prevent the attack.

The good thing about nitroglycerine is that it is not dangerous or habit forming. It does not cease to be effective even after years of use.

But a few sensitive patients cannot take it orally because it causes a severe pulsating headache in them. To prevent this, nitroglycerine has now become available in an ointment form, which can be applied to the chest and used 'as a slow-release preparation. An application at bedtime may give the patient a good night's sleep.

Long-acting nitrates, of which isosorbide dinitrate (Sorbitrate, Isomack Retard) is most preferred, are useful in some cases. Though not as effective as nitroglycerine, isosorbide dinitrate can be helpful in prolonging the interval between anginal attacks. Hence, it is often advised in patients suffering from frequent anginal attacks. They need to take it on a regular basis, every few hours.

If these measures fail to provide the patient a reasonable life, two newer families of medicines popularly referred to as the beta blockers and the calcium blockers may have to be considered. They are effective in reducing the frequency and intensity of anginal attacks.

The beta blockers are a large family of many generations of medicines. The first was propranolol (Ciplar, Inderal), formulated in 1970. Successive generations, each with a claim to special value, have since sprung up. Of these, atenolol (Betacard, Tenolol) and metoprolol (Betaloc, Metolar) are currently the most valued, as they act selectively on the heart.

The beta blockers work by decreasing the oxygen demand and contractility of the heart.

They cannot, however, be given to patients with heart failure, slow heart rate, incomplete heart block, or peripheral vascular disease. in patients of asthma, obstructive airway passage disease, or unstable diabetes, only the newer generation of cardio-selective beta blocker medicines (atenolol, metoprolol) may be given with due caution.

The calcium blockers are the newest entrants to the antianginal medications. It is to this family that verapamil (Isoptin, Vasopten, Vera mil, Veratril) and nifedipine (Calcigard, Myogard, Nifelat, Nificard)-the two most popular medications in current use-belong.

These medications act by increasing the diameter of coronary arteries. Thereby, they come in extremely useful in treatment of Prinzmetal's angina and other forms of angina in which coronary spasm plays a role. As they reduce the oxygen demand of the heart, they are useful in treating chronic stable angina too. They are safe in patients with asthma, diabetes, and peripheral vascular disease. But as in the case of beta blockers, it is prudent to use them cautiously in patients with poor heart function.

Generally, as with all medications, it is wise to adhere to the doctor's prescription if you are on one or the other anti-anginal drug. No meddling is allowed either with time or dose schedule. If there are any problems, it is best to consult your doctor. A sudden stopping of the drug on your own, particularly beta blockers, is fraught with risks of life-threatening complications.

When does the need for surgery arise? Top

Medical therapy alone is very effective in many patients of angina. Only when medical therapy fails, or the disease critically affects three coronary vessels or the left main coronary artery stem, does the need for coronary bypass surgery arise. In some cases coronary angioplasty, a much simpler procedure, can be equally rewarding.

What is the prognosis for a patient of angina today? Top

A variety of factors decide the outcome. With rapid advances in the treatment, including surgery, angina is no longer a Damocles' sword, as it was once thought to be. Many patients live relatively healthy lives for as long as fifteen to twenty years. Yet, in some, life may be suddenly cut short by a heart attack, or its complications.

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