Agatha M. Thrash, M.D.
Preventive Medicine
Angina pectoris is the name of chest pain due to some malfunctioning of the heart, and is usually called simply “angina.” The usual location of the pain during an attack of angina is behind the middle or upper third of the breastbone. The pain is usually centered at the level of the third or fourth rib. It may be transmitted down the arm or felt in the left shoulder blade, left wrist or elbow, in the uppermost part of the abdomen where one usually feels heartburn, and rarely even in distant structures such as a carious tooth, an inflamed gallbladder or such. When the pain is severe it tends to radiate to the neck or jaw or to one or both upper extremities. The pain may be mild and barely noticeable, or excruciating and crushing. The person having an attack may feel nothing more serious than pressure. Occasionally a certain attitude of mind such as a sense of impending death, a sensation of stage fright, or some vague fear, accompanies the pain.
An angina attack usually lasts only a few minutes; 97% last less than 3 minutes. The patient may greatly overestimate the duration, feeling that 30 or 45 minutes were involved. If pain last for more than half an hour, one should be investigated for a heart attack rather than simply angina. Anginal pain may occasionally persist for several hours, but this is the exception rather than the rule.
Angina may occur following physical effort such as walking up and down stairs, may occur while the patient is at rest, or only when the patient lies down. It may appear during the night without apparent cause, and may be the type called “intractable angina” which is chronic cardiac pain.
There are several factors that tend to bring on angina; physical exertion is the commonest. Exposure to cold greatly enhances the probability of an attack of angina with exercise or digestion. Intense emotional states can bring on angina, as can overuse of insulin or thyroid extract, the use of tobacco, passing one’s urine or bowel movement, or the presence of anemia or high blood pressure.
Ways to treat angina include first warming the body in various ways. One may take a hot foot bath or warm sitz bath. The hands and feet may be placed in hot water. Take a hot nasal bath with a bulb syringe arranged with a rubber band on the tip so it will fit snugly in one nostril, pressing hot water out of the bulb into the nose while bending over a sink so that the hot water may run out of the opposite nostril.
One should remember that increased activity of digestion can cause angina; therefore it is wise to avoid overeating or the use of heavy foods. Any food having a high calorie content per unit volume of food should be avoided. This would include heavy fats and sweets, foods rich with milk or cream, cheese, meats, eggs, nuts, wheat germ, and other concentrated foods. Generally speaking, the empty calories can be eliminated entirely. This would include all soft drinks, free sugars, all cooking oils, margarine, mayonnaise, and fried foods.
A vegan diet
A vegan diet, one that contains no meat, milk, eggs, or cheese, has advantages in both the prevention and the treatment of heart disease and angina pectoris. Of course, smoking should always be prohibited in a patient who has any kind of heart disease. A physician who fails to warn his patient about tobacco could be judged guilty of malpractice.
Since exercise is one of the principle features of the treatment of coronary disease, it should be used in the treatment of angina. When one feels an attack of angina coming on with exertion, one should slow one’s pace to the point that the angina stops, but preferably one should not stop activity. When a progressive exercise program is accompanied by a diet containing no free fats or sugars, no animal products, and a program to bring the weight to ideal, one can expect to gain control over their angina. The ideal weight is as follows: Compute the height in inches and multiply by 4 for a man and by 3.5 for a woman. From the figure obtained, subtract 128 for men and 108 for women to obtain the approximate ideal weight for the person with angina.
In order to prevent exertional angina it is well to have a warm-up phase before all actual exercise workouts, and then a cool-down phase at the end. The warm-up and cool-down should last about five minutes each, and the work-out phase should consist of about thirty minutes of activity. The rate of activity should increase the heart rate to 75% of the heart rate attained during a preconditioning exercise tolerance test. In case this tolerance test was not obtained one can approximate the vigor of activity one should engage in by counting the resting pulse rate, and exercise at a pace that will make the pulse rate 20% above the resting level. If the resting pulse is 80 the exercise pulse should be around 96 for a person with angina at the start of an exercise program. Gradually build up the intensity and duration of the exercise. The cool-down period should be characterized by puttering around the house or yard at a very slow pace until sweating and heart rate have returned to pre-exercise levels, which usually occurs within five minutes. Angina is caused by an imbalance between the need for oxygen by the heart muscle and the ability of the blood vessels to deliver the needed oxygen. Physical exercise increases the threshold of most angina patients to pain.
For more information contact:
Uchee Pines Lifestyle Center
30 Uchee Pines Road #75
Seale, Alabama 36875
Tel. 334-855-4764
www.ucheepines.org
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