Nondrug Treatment For Angina

NONDRUG TREATMENT
A. Weight Reduction Effects
If you have angina and you lose 10–25 lb, you will
certainly experience less pain, you will require a smaller
dose of antianginal medication, and you may not require
angioplasty or surgery.
Weight reduction, relief of stress, a low-saturated fat
diet, and avoidance of smoking are the most important
nondrug treatments for patients with angina. Weight loss
depends on eating less calories and burning off more
calories during exercise. A combination of a low-calorie
diet with some form of exercise program that increases
caloric expenditure must be followed, otherwise the
weight gain that often occurs after stopping a low-calorie
diet will ensue. All diets that are proven to cause weight
loss over a period of years depend on reduced intake of
calories. Calories do count, do not let anyone tell you
otherwise.
Weight loss occurs with reduction of calorie intake to
less than 1000 calories daily and exercise to burn off more
calories. A meal should contain a moderate amount of
protein, but a low-saturated fat content. Reduce your
intake of high-calorie foods containing refined sugars or
starches. A greater than 75% decrease in the usual
consumption of all products derived from wheat flour,
potatoes, and rice along with 40 minutes of exercise daily is
guaranteed to cause significant weight loss.
Fish three times weekly, even canned tuna, salmon,
sardines, and herring, will help to reduce the saturated fat
in the diet. Many individuals may stick to these rules, but
forget that alcohol, both mixes and beer, are high in
calories. Avoid fast foods because they often high in
calories and salt. An increase in salt increases the work of
the heart muscle and puts a strain on the heart, which can
lead to heart failure and shortness of breath. Thus, patients
with high blood pressure, heart failure, and angina are
advised to follow a low-salt diet.
Lack of motivation often results in a failure to reduce
weight. It is a tough battle for most overweight individuals
to fight on their own, and success is more often obtained
by joining a weight-loss program or clinic. We strongly
advise you to consult your physician or to contact your
Heart and Stroke Association for recommended publications
on weight loss. The Mediterranean style diet is
cardioprotective and strongly recommended, see chapters
Diets and Heart Disease and Dyslipidemia.
B. Exercise
What about exercise and angina? An exercise stress test
using a treadmill or bicycle under the supervision of a
physician should provide the answer to the question:
‘‘How much exercise is safe for me?’’ Usually, a safe level of
exercise is that which will bring on only mild discomfort or
mild shortness of breath. You should slow down for a few
seconds then stop for a minute or so before continuing the
activity (such as a quarter- or half-mile walk). Stretching
exercises and walking — including climbing two or three
flights of stairs daily — will improve your muscle tone.
Exercise alone, however, cannot remove the obstruction
caused by plaques in arteries. Patients with angina do not
jog because this activity often precipitates pain. For more
information, see the chapter Exercise and the Heart.
C. Smoking
Nonsmoking men are 10 times less likely to have a fatal or
nonfatal heart attack than heavy smokers. Sudden death
by heart attack is more common in heavy smokers than
in nonsmokers. Drugs that are effective in preventing
angina and death lose their effectiveness in smokers
because the by-products of cigarettes interfere with the
breakdown of the drugs in the liver. These drugs include
the frequently used beta-blocker propranolol and calcium
antagonists such as nifedipine. Also, bypass grafts become
blocked within a few years of bypass surgery in patients
who continue to smoke. If you have angina and chronic
bronchitis, cigarette smoking will cause an increase in
shortness of breath.
Women between the ages of 35 and 50 who have
functioning ovaries rarely suffer from angina or have heart
attacks. Women who smoke and have an elevated blood
cholesterol level, unfortunately, increase their risk of having
a heart attack and angina prior to age 50.
Perhaps, rather than quitting, changing to a different
brand of cigarettes is considered. The bad news is that
filter cigarettes and low-nicotine or low-tar brands of
cigarettes do not decrease the risk of heart attacks. In fact,
filter cigarettes deliver more carbon monoxide to the
smoker’s system and cause more heart attacks than plain
cigarettes.
The oxygen supply to the heart muscle is low in patients
with angina. Angina patients who are smokers experience
pain at lower levels of exercise. Nicotine causes a slight
increase in the heart rate and a rise in blood pressure;
therefore, the heart muscle demands more oxygen. Carbon
monoxide delivered from cigarettes steals oxygen away
from the heart muscle, which is already deprived of
oxygen. So the combination of carbon monoxide and
nicotine is bad news. Regardless of the present condition
of your heart, do yourself a favor and quit smoking.
Still, how do you stop smoking? It is easier said than
done. The first step is motivation. Consider the facts. The
dangers of carbon monoxide are well known. You wouldn’t
stand around inhaling exhaust fumes from a car, especially
if its engine was running in an enclosed garage; you
know that that situation would cause death. Yet, we have
information today that proves heavy cigarette smokers are
exposed to eight times the level of carbon monoxide
considered safe in industry, and it has been proven that
heavy cigarette smoking is a cause of heart attacks and
sudden death.
The addiction to nicotine is so powerful that nothing
will help if the smoker is not motivated to quit. Even
bronchitic patients continue to smoke because the addiction
to nicotine is so great. To help you to quit smoking,
enlist the assistance of stop smoking clinics; even hypnosis
is a viable alternative. The American Cancer Society and
the National Cancer Institute provide several types of
programs to help smokers quit. Local cancer societies
usually provide a list of programs that can help. Consult
a physician for advice on nicotine tablets, patch, gum,
or nasal spray. Most smokers who cannot motivate
themselves. Get help now!

D. L-Arginine
Arginine increases nitric oxide availability in the arterial
wall and this causes vasodilation and increases blood flow.
Some clinical trials indicate modest improvement in
angina symptoms with its use, but they are not consistent.
Arginine is found in many foods and an arginine food bar
is also available.



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Diagnosis Of Angina

Pain Pattern
1. Location
The pain of angina is usually felt in the center of the chest
over the breastbone, and only rarely over the breasts. Pain in the lower jaw
accompanied by pain in the chest or arms during a walk or
strenuous activity is nearly always due to angina, especially
if these symptoms recur during similar activities.
Sometimes the discomfort is only in the upper arm with a
tingling feeling in the fingers; this pain comes mainly
on exertion as opposed to pain produced, for example,
by a pinched nerve. A pinched nerve will cause similar
discomfort in the arms and fingers when the individual
is at rest, but an activity, such as walking, makes little
difference.
2. Severity and Character
The pain of angina may be mild to moderate and only
occasionally severe. Often it is just discomfort. The
individual may even refuse to use the word pain to describe
the peculiar sensation that feels like a tightness or a
heavy weight on the breastbone. To some it is a burning
sensation; to others it is a feeling of strangulation or
suffocation that fortunately disappears within one to five
minutes of rest, either with the individual standing or
sitting. The pain of angina rarely lasts more than 10
minutes. If an individual has pain similar to that described
and lasts more than 15 minutes, the patient should take
two or three soft, chewable aspirins (80 mg each) and go
immediately to a hospital emergency room.
Activities that Precipitate Angina
These precipitating activities include:
1. Walking up a hill
2. Walking against the wind
3. Running with some associated anxiety for a bus or to a
place, especially while carrying a bag; anxiety is made
more profound if the individual is late and must rush,
thus, there is exertion and emotional stress
4. A brisk walk or similar exertion soon after eating; this
does not include bending and stooping, which can
precipitate indigestion
5. Unaccustomed exertion
6. Emotional distress; for example, bad news, a scare,
anger, rage, nightmares, etc.
7. Pain may occur during overwhelming excitement; for
example, watching your team playing football, hockey,
baseball, basketball, and similar exciting programs
Most important, relief of pain in an individual with
stable angina always occurs within minutes of cessation of
the precipitating exertional or emotional activity. Relief
with nitroglycerin occurs promptly within one to two
minutes.

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