Angina pectoris treatment. Cause, symptoms, diagnosis and investigations and homeopathy medicines for angina treatment.

Angina pectoris is a transient chest pain with discomfort that results when the heart’s demand for oxygenated blood exceeds supply from the coronary arteries. This decreased supply of oxygenated blood usually results due to spasm in the coronary artery.

Symptoms and signs of angina pectoris resemble myocardial infarction. During the course of attack of angina pectoris, the patient experiences chest pain with heaviness, pressure, suffocation, tightness, choking or squeezing. The typical discomfort is sub-sternal in location.

The attack of angina pectoris occurs during physical or emotional stress and is relieved by rest. The syndrome of angina pectoris may occur due to fright, shock, hurrying, anger, exertion, violence, sexual activities, walking against the wind, ascending staircases, walking uphills, walking on ramps as well as by having heavy meals and during exercise. Angina may also occur during or after eating, exposure to cold temperature or to wind.

The main cause of occurrence of angina is only when the workload on the heart is increased and furthermore the most common cause of angina is due to accumulation of atheroma (fatty deposits/bad ‘cholesterol’) inside the blood vessels wall, which causes obstruction in the normal flow of the blood to the heart.

Due to deposit of atheroma, the passage becomes narrow in the blood vessels and if the normal coronary artery becomes totally blocked, the heart attack takes place. Thus, the angina is a symptoms of coronary artery disease and in other word it is a sign of future heart attack (due to impairing the pumping ability of the heart).

The pain is normally experienced in the chest, behind the sternum, neck, jaw, throat, back, left shoulder, abdomen, left wrist and in the left arm with numbness or heaviness as well as with peculiar sensation of anxiety and fear of death. The pain is knife-like and cutting (stabbing pain) may accompany the feeling of cold, sweating and breathlessness. Angina is always of a short duration, say 1-2 minutes.

However, if the chest pain persists ten minutes or more and is not relieved by rest, there is a possibility of heart attack. Therefore, all chest pain should be considered seriously and the medical assistance and care is required immediately.

Angina Pectoris is more common in men than woman (The heart’s size and work load are usually smaller in women) aged 35-60 years, who normally take rich diet, smoke and do not exercise.

Pathophysiology of angina pectoris

Acute myocardial ischemia occurs when myocardial oxygen demand exceeds supply-

• Narrowing of the coronary artery due to arthrosclerosis
• Non arthrosclerosis coronary artery disease such as coronary spasm
• Valvular heart disease
• Systemic hypertension
• Pulmonary hypertension
• Syphilis (Coronary osteal stenosis)
• Aortic regurgitation
• Kawasaki’s disease
• Severe anemia
• Emboli to coronary arteries (e.g. infective endocarditis).
• Hypertrophic or dilated cardiomyopathy
• Precipitating causes of angina pectoris

Precipitating causes of angina pectoris

• Heavy meal
• Physical exertion
• Emotion or excitement particularly anger and anxiety
• Exposure to cold
• Hyperinsulism in diabetic patients
• Straining at stool
• Sexual intercourse
• Micturition

Types of angina pectoris

Angina is classified in three main types

1. Stable angina
2. Unstable angina
3.  Prinzmetal’s angina

Stable angina – angina is said to be stable when there is no change in frequency, duration and precipitating factors, mostly symptoms occurs during exertion and last for less than five minutes and relieved by rest.

Unstable angina – in unstable angina symptoms are symptoms are more severe, angina of effort with increasing frequency and duration, provoked by less than usual stimuli and occurs at rest.

Prinzmetal’s angina – Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful. Prinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.

Symptoms of angina pectoris

Symptoms of angina pectoris mainly include

• Breathlessness or dyspnoea
• Chest pain over middle or lower sternum or behind the sternum
• Palpitation
• Sweating
• Chest pain with “vice like” constriction or chocking
• Extension of pain to right or left arm, forearm, fingers, neck and jaw.
• Dizziness
• Faintness
• Apprehension
• Rapid heart rate

The clinical appearance is as follows:

• Chest pain lasting 3 to 5 minutes— not all patients get substernal pain; it may be described as pressure, heaviness, squeezing, or tightness. Use the patient’s words.
• Can occur at rest or after exertion, excitement, or exposure to cold-due to increased oxygen demands or vasospasm.
• Usually relived by rest — a chance to re-establish oxygen needs.
• Pain may radiate to other parts of the body such as the jaw, back, or arms- angina pain is not always felt in the chest.
• Sweating (diaphoresis) —increased work of body to meet basic physiologic needs; anxiety.
• Tachycardia — heart pumping faster trying to meet oxygen needs as anxiety increases.
• Difficulty breathing, shortness of breath (dyspnea)- increased heart rate increase respiratory rate and increases oxygenation.
• Anxiety – not getting enough oxygen to heart muscle, the patient becomes nervous.

Clinical Diagnosis of angina

History

Clinical diagnosis of angina pectoris depends on the history of chest discomfort. Differentiation from other causes of chest pain is by careful analysis of site, duration, aggravating factor, relieving factor, radiation and other aspects of the chest discomfort.

Physical Examination

Physical examination is usually normal Diagnosis depends on history and ECG changes.

It is important to look for any aggravating factors.

Aggravating Factors of Angina

• Anemia
• Hypertension
• Thyrotoxicosis
• Aortic stenosis
• Hypertrophic Cardimyopathy

Investigations for Angina

Investigations in case of stable angina

• Echocardiography
• Stress echocardiography
• Intravascular ultrasonography
• Intracoronary Doppler

Main Investigations in case of unstable angina pectoris

ECG (EKG) – at rest may show ischemia changes especially in acute phase of illness. ECG is the single most important investigation and should be done in all patients with suspected angina. ECG at rest may be normal in about 25 to 50% of patients.

Echocardiography can detect abnormalities of ventricular wall motion due to ischemia or myocardial infarction. Stress (exercise) echocardiography is more sensitive than exercise ECG in the diagnosis of IHD. Echocardiography should be done to asses left ventricular function in patients with angina.

ECG changes associated with myocardial ischemia include horizontal or down-sloping ST-segment depression or elevation [≥ 1mm (0,1mV) for ≥ 60-80ms after the end of the QRS complex]. ST-segment depression is associated with an 100% increase in the occurrence of three-vessel/left main disease and to an increased risk of subsequent cardiac events. Left main and 3-vessel coronary artery disease shows a frequent combination of leads with abnormal ST segments: ST-segment depression in leads I, II and V4-V6, and ST-segment elevation in lead aVR.

Stress Testing (TMT)

This is most commonly used test for making the diagnosis and determining the prognosis of angina. ECG is recorded before, during, and after exercise. It is abnormal in about 80% of patients.

Stress Thallium -201 Myocardial imaging

This is superior to exercise ECG for the diagnosis of angina pectoris, but this test is not widely available.

Coronary angiography – should be done in all cases where atherosclerosis or emboli are suspected.

Difference Diagnosis of angina symptoms

Conditions which Cause Chest Pain Very Similar to Angina Pectoris

1. Oesophageal spasm
2. Gastrop-oesophageal reflux
3. Musculoskeletal pain
4. Anxiety and hyperventilation
5. Pericardial pain
6. Pulmonary embolism
7. Aortic dissection

Homeopathy Treatment of Angina pectoris

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach.

This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering.

The aim of homeopathy is not only to treat angina pectoris but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat angina pectoris that can be selected on the basis of cause, sensations and modalities of the complaints.

For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of angina pectoris:

Glonine, Cactus, Amyl Nitrate, Crataegus, Lachesis, Naja, Aconite, Spigelia, Arsenic Album, Mag Phos, Cimicifuga and many other remedies..

Angina / CAD – Permanent Cure