Angina

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Angina

17 Ways to Stop the Pain

Ollie slumps on the couch after gorging himself on Eula Mae's latest offering of his favorite meal: roast ham, baked potato with sour cream, hot, buttered corn on the cob, and apple pie ˆ la mode. He lights up a cigarette. But he can't relax because he and Eula Mae are beginning their nightly postdinner argument—this time over who's going to shovel the snow. It's not long before an aggravated, red-faced Ollie rolls off the couch and waddles out into the frigid January night, vanquished once again.

Minutes later, Ollie is gasping and clenching his chest in pain as a heavy, squeezing pressure radiates from his heart. "Oh, Lord!" he cries. "Eula Mae! Eula Mae! This is The Big One! I'm a goner fer sure! I want to live!"

But it's not The Big One, and Ollie is not headed for that Big Greasy Spoon in the Sky. Five minutes later the pain has subsided and Ollie recalls what Dr. Hartebeest had told him just last week. His pain is not a heart attack, and it's not heartburn. It's angina. And it's a sign that the arteries in Ollie's heart are clogging up with fat. The blood can't get through to nourish his heart. That high-fat, high-salt feast, that argument with Eula Mae, going out into the cold, shoveling snow. Any one of those things can bring on angina.

"Here are some pills to take when you get the pain." Dr. Hartebeest had said. "But I'm warning you, Ollie. If you don't change your ways, you're asking for trouble."

What are poor Ollie and others like him to do? Here's what the experts advise.

Get a new outlook on life. Sidney C. Smith, Jr., M.D., director of cardiology at Sharp Memorial Hospital in San Diego, California, is tough and outspoken about the need for angina patients to see the light and make some lifelong lifestyle changes.

MEDICAL ALERT The Signs of Trouble You've been diagnosed as having angina—attacks of chest pain that result from a decrease in the supply of blood to your heart. You know what induces an attack and how to avoid it. You also know what to do when you feel one coming on. But do you know when your symptoms are saying something else, when something serious could be wrong? If not, here are a few signs that say "see your doctor—ASAP." You've been exercising to a certain level without getting angina, but now you're beginning to get angina at that level. You experience angina at a lower level of exercise than before. You've had stable angina (attacks that come on only with exertion), but now you've developed unstable angina (attacks that occur during rest). These may all be signs that the arterial blockage that affects blood flow to your heart is getting worse, says Sidney C. Smith, Jr., M.D. Another warning sign is angina pain that lasts for more than 15 to 20 minutes. "This could be a sign of heart attack or what we call coronary insufficiency, which is the most extreme form of unstable angina," says George Beller, M.D. "Coronary insufficiency causes prolonged pain but without the irreversible damage characteristic of a heart attack. But you can't tell the difference, so consider it a medical emergency."

"It's a source of major concern to me to see patients take expensive drugs and not make a commitment to modify their lifestyles," he says. "They're only going to get angina again. At times we look for quick answers to tough problems. That doesn't work with angina and heart disease."

"I spend a lot of time educating patients about their symptoms, what to do when they have them, the importance of clean living." he says. "But we don't feel we've done a complete job unless the patient is involved." With a good attitude and the desire to live a healthier life, the other necessary changes will come a whole lot easier.

Clear the air. For those of you who smoke, kicking the habit is the most important thing you can do. On a scale of one to ten, it rates a ten, stresses George Beller, M.D., professor of medicine and head of the Division of Cardiology at the University of Virginia School of Medicine. Smoke increases blood levels of carbon monoxide, which displaces oxygen. And since angina is an artery-clogged heart crying out for oxygen, smoking is clearly the worst thing you can do. On the other hand, Dr. Beller notes, those who quit usually show an immediate decrease in episodes of angina.

What's more, cigarette smoke makes your blood platelets stick together, further blocking your partially blocked arteries. Last, but far from least, smoking diminishes the effects of any medication you may be taking.

Here's another fact that may help encourage you to quit. Studies have found that angina patients who quit smoking have half the death rate of those who continue.

Think "less is best" when eating. This means less salt, less fat, less calories. "Just one overly fatty, overly salty meal can cause an angina attack because it raises your blood pressure suddenly," Dr. Beller says.

To control the level of fat in your diet, most doctors and the American Heart Association suggest a diet containing less than 30 percent of calories from fat. This means cutting back as much as possible on foods containing saturated fat—the kind (such as butter) that hardens at room temperature—and cholesterol. Here are a few good ways to get started.

• Eat no more than 6 ounces of meat, seafood, or poultry daily.
• Eat only meat that is lean and trimmed of all fat, and trim it before cooking. Ground beef should be labeled as having no more than 15 percent fat.
• If possible, remove the skin from poultry before cooking. If not, remove it before eating.
• Learn to use meat, fish, and chicken sparingly in meals. For example, serve it stir-fried in heart-healthy monounsaturated oil (like olive oil) or polyunsaturated oil (like vegetable oil), with lots of vegetables.
• Limit your daily intake of all oils to 5 to 8 teaspoons. And use only monounsaturated or polyunsaturated oils.
• Eliminate cholesterol-rich organ meats, such as liver, kidney, or heart.
• Eat only nonfat or 1 percent fat milk products. And be careful when checking out the cheese counter. Some low-fat cheeses are high in salt.
• Increase your daily intake of fresh fruits and vegetables and eat more grains, particularly oat bran, which has been shown to help bring down cholesterol levels. (For more on reducing cholesterol, see page 135.)

Exercise angina away. Lots of angina patients like to sell themselves on the notion that exercise is out of the question because it exerts the heart, and since exertion brings on angina, exercise should be avoided. This just isn't so, says Dr. Beller.

Julian Whitaker, M.D., founder of the Whitaker Wellness Institute in Newport Beach, California, has firsthand knowledge of how important exercise can be for angina patients. He likes to tell the story of a group of patients awaiting heart transplants who were put on an exercise program to strengthen them for surgery. "Over a period of several months, half improved their heart function so much they no longer needed the surgery," he says.

"It's almost routine that when patients start an exercise program, they will experience angina at the beginning of a session," Dr. Whitaker says. "Angina is not a reason not to exercise."

But people with angina need to stay attuned to their bodies, Dr. Beller notes. "If they feel an attack of angina building up, they should know that if they slow down it will dissipate without their having to stop completely."

Why, you may wonder, is exercise so crucial? For one thing, exercise is a proven stress releaser, says Dr. Beller. And it will also help you lose weight. Both stress and overweight are counterproductive to heart health. "It will also lower your heart rate and reduce your blood pressure, which, in turn, will help reduce your need for medication."

Exercise produces these changes, Dr. Whitaker notes, because exercise-trained muscles can pull more oxygen out of arterial blood. "That decreases the amount of work the heart has to do to pump the same amount of oxygen to the muscles," he says.

Both Dr. Beller and Dr. Whitaker agree that exercise alone is no panacea. It takes exercise and diet combined to be effective.

Before you start exercising, consult your doctor and get a stress test. "That way you know what your limit is, and you can gain confidence," Dr. Beller says. "You have to have a dialogue with your doctor on what you both consider to be tolerable pain and what isn't." Always be sure to warm up gradually, Dr. Whitaker adds, especially if you're going out into cold temperatures.

Learn to relax. "Whether it's relaxation exercises or meditation, learn how to control your emotions instead of having them control you," advises Dr. Beller. "I have patients who never get angina except when they have a fight with their spouse, yet they can exercise with no problem.

"Work on resolving your conflicts and you can do as much to improve your angina as if you just took more drugs," he says.

The Alternate Route Fat: How Low Can You Go? Can you live a life totally devoid of butter, cream, cheesecake, and eggs? Can you steer clear of fatty foods, like ribs, and salty foods, like fries, and devote your diet to vegetables, fruits, and whole grains? Sure you can, says Monroe Rosenthal, M.D., medical director of the Pritikin Longevity Center, Santa Monica, California, because thousands of people have done it and continue to do it, and they have shown a remarkable improvement in their heart health as a result. "We recommend a diet in which 10 percent of calories come from fat," states Dr. Rosenthal. That means no more than 3 1/2 ounces per day of fish, poultry, or lean meat. And since the average American diet comprises 50 percent of calories from fat, that's a pretty drastic cutback! "Sure, it's tough," Dr. Rosenthal says. "Some people do go on the diet and fall off. But it's a great alternative to heart bypass surgery or to being apprehensive all the time that you're going to get chest pain whatever you do. The diet requires commitment, a positive attitude, and some effort." But the payoff, he says, can be big. "Blood pressure drops, cholesterol drops, episodes of chest pain decline, and clinical symptoms improve," he says. "Frequently we can completely eliminate certain medications." One study of 893 Pritikin patients, for example, showed that their cholesterol levels dropped an average of 25 percent after just four weeks on the diet. And 62 percent of the angina patients left, drug-free, while many others were able to reduce their need for medication after finishing the complete program of diet, exercise, and education. How realistic is a goal of 10 percent of calories from fat? Sidney C. Smith, Jr., M.D., says it is attainable by only 10 percent of the population. The recommendations from mainstream medicine and the American Heart Association (AHA) to cut back to 30 percent of calories from fat are more realistic. "These guidelines are effective and attainable by a fairly large percentage of the population," he says. But, he adds, he'd like to eventually see the guidelines get even lower. "In my own diet I'm a lot stricter than the AHA guidelines. I've made those changes in my own life." And that, in Dr. Rosenthal's opinion, is the bottom line. "It's not really a diet—it's a way of life."

Take an aspirin a day. For those with unstable angina (the kind that can hit you without exertion, such as when you're resting or even sleeping), aspirin can be a lifesaver, some doctors believe.

"It appears that aspirin prevents the initial activation of the blood clotting mechanism," says Dr. Beller. If your blood clots too easily, of course, it can't get through the narrowed artery and can trigger a heart attack.

In a study conducted at a Canadian hospital, researchers found angina patients reduced their chances of heart attack by 51 percent by taking four buffered or coated aspirin tablets daily. As a result of this and similar studies, many physicians recommend one aspirin daily for minimum effectiveness.

All heart patients, however, should get their doctors' approval before starting on aspirin. Even though it is an over-the-counter drug, aspirin can have side effects. In addition, it could interact with other medication you may be on.

Put your body on tilt at night. If you experience angina attacks at night, tilting the head of your bed up 3 or 4 inches can reduce the number of attacks, says cardiologist R. Gregory Sachs, M.D., assistant professor of medicine at Columbia University College of Physicians and Surgeons. Sleeping in this position makes more blood pool in your legs, so not so much returns to the heart's narrowed arteries. And it may help reduce a need for nitroglycerine.

Put your foot down. If you do get angina attacks at night, Dr. Sachs suggests an alternative to reaching for a nitroglycerine tablet. Simple sit on the edge of the bed with your feet on the floor. "It is equivalent to the effect of nitroglycerine," he says. If you don't feel your symptoms begin to subside quickly, then reach for your medication.

PANEL OF ADVISERS

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George Beller, M.D., is a professor of medicine and head of the Division of Cardiology at the University of Virginia School of Medicine in Charlottesville, and chairman of the Council on Clinical Cardiology of the American Heart Association.

Monroe Rosenthal, M.D., is medical director of the Pritikin Longevity Center in Santa Monica, California.

R. Gregory Sachs, M.D., is a cardiologist in private practice in Summit, New Jersey, and an assistant professor of medicine at Columbia University College of Physicians and Surgeons in New York City.

Sidney C. Smith, Jr., M.D., is director of cardiology at Sharp Memorial Hospital in San Diego, California, and associate clinical professor of medicine at the University of California, San Diego, School of Medicine.

Julian Whitaker, M.D., is founder and director of Whitaker Wellness Institute in Newport Beach, California, where he specializes in nutritional therapies for heart disease and high blood pressure.