Angina

---

Angina

Nearly three million Americans have experienced an angina attack, which usually lasts about ten minutes. It's not the same as a heart attack, but because of its chest-crushing severity, it often seems like one. And failing to control angina makes you an ideal candidate for a heart attack. Angina is one of the first signs of serious heart disease.

If you've already been diagnosed with angina, your doctor probably has you on medication. But here are some home treatments that can help you manage or even reverse angina.

Eat vegetarian. A steak-and-potatoes diet (with extra butter and sour cream) may have caused your angina by boosting the levels of cholesterol in your blood, but a strict vegetarian diet may help cure it-often sooner than you may think. Dean Ornish, M.D., director of the Preventive Medicine Research Institute in Sausalito, California, and author of Dr Dean Ornish's Program for Reversing Heart Disease, recommends that people make comprehensive changes in their diet and lifestyle. He suggests a low-fat vegetarian diet that includes no animal products except for skim milk, egg whites and nonfat yogurt.

"When they follow this diet, most people find that the severity and frequency of angina pain diminish markedly within a few weeks, or even a few days," says Dr. Ornish. A vegetarian diet can also prevent angina pain and help keep arteries clean, because dietary cholesterol is present only in meat, milk, egg yolks and other animal products. And those foods also are high in saturated fat, which your body converts to cholesterol.

If you eat meat, go lean and light. If you still want to eat meat, fish or poultry, you should limit it to no more than six ounces daily. Also, choose cuts that are lean and trimmed of all visible fat. If you eat ground beef, it should be labeled extra lean. Be sure to avoid cholesterol-rich organ meats such as liver, kidney and heart. And remove all skin from poultry before cooking.

Boost your vitamins--A, C and E. Here's another benefit of a low-fat vegetarian diet: It's rich in the antioxidant vitamins A, C and E--three nutrients that have been found to help prevent or control angina.

"If your diet consists mainly of vegetables, fruits and whole grains, then you're getting all the key nutrients you need," says Frank E. Rasler, M.D., an emergency room physician and a researcher at Emory University School of Public Health in Atlanta.

When to See the Doctor Although you should remain under a doctor's regular care once you've been diagnosed with angina, here are some warning signs that should prompt you to see your doctor at once. You experience chest pain that lasts more than 15 minutes (and is not relieved by three nitroglycerin tablets taken in succession 5 minutes apart). This could suggest a heart attack rather than angina, and you should go to the hospital immediately. You had gotten attacks only with exertion before but are now experiencing attacks during rest. You'd been able to exercise at a certain level without any angina pain, but now you feel pain when you exercise at that same level. You're experiencing pain when you exercise at a level that's less than before.

Take aspirin. Taking aspirin regularly, according to a dosage regimen recommended by your physician, can reduce heart attack risk. A dose as small as one baby aspirin daily has helped patients with unstable angina--the kind that can hit you when you're resting or even sleeping.

"It appears that aspirin helps prevent blood clots," says George Beller, M.D., professor of medicine and head of the Division of Cardiology at the University of Virginia School of Medicine in Charlottesville. If clots form too easily, your blood can't get through the narrowed artery, and that blockage could trigger a heart attack.

A caution: Be sure to get your doctor's approval before starting on aspirin. Even though it is an over-the-counter drug, aspirin can have side effects, and it could interact with other medications you may be taking.

Get a regular workout. Even though angina pain is sometimes triggered by exercise, you should still work out regularly. Exercise helps improve blood flow to the heart, and it also relieves the stress that helps trigger angina attacks.

"When patients start an exercise program, they may experience angina with increased exercise levels," says Dr. Beller.

The answer: Exercise until you begin to feel the onset of discomfort or pain, then stop until the pain subsides--which may require taking a nitroglycerin pill. Often you can then continue, and the pain will not return. Ultimately, an exercise regimen will improve exercise tolerance, with angina occurring only with greater exercise stress than when you first started.

Exercise good judgment. People with angina need to exercise certain precautions. For instance, inhaling carbon monoxide can trigger an angina attack, so if you run, do it away from traffic.

If you live in an urban environment, try to exercise indoors. In fact, just being exposed to everyday levels of carbon monoxide can cause angina prematurely in some people, says Sidney Gottlieb, M.D., a cardiologist and associate professor of medicine at Johns Hopkins Medical Institutions in Baltimore.

Also, exercising in the bitter cold can trigger angina attacks in some people. So for winter workouts, be sure to cover your face with a scarf.

Raise your headboard. If you experience angina attacks at night, raising the head of your bed three or four 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 in New York City. 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 the need for nitroglycerin, the drug of choice for stopping angina pain. You should check with your doctor, however, before reducing any regular medication.

What You Should Know about Nitro Placing a nitroglycerin tablet under your tongue is frequently prescribed to halt an angina attack. Unfortunately, some studies have shown that two in three people who use nitro don't know how to use it properly. Here are some recommendations given to angina patients by Frank E. Rasler, M.D., an emergency room physician and a researcher at Emory University School of Public Health in Atlanta. Have a seat. You should be sitting or lying down when you take nitro. "Some patients have a drop in blood pressure that can cause them to faint if they're standing," says Dr. Rasler. Keep pills sealed. Exposing pills to light or air decreases their effectiveness. So always keep them in a sealed brown bottle and close the bottle tightly after taking the pills you need. They should be replaced after three or four months. Take pills that cause a burning or tingling sensation on the tongue. This indicates they're still working. "If you don't notice some sensation, it indicates the pills have lost their effectiveness and should be replaced or the pill is not dissolving due to lack of moisture under the tongue," says Dr. Rasler. Drink water or juice. For a variety of reasons, some people have a very dry mouth during an angina attack. In this case, it is essential to moisten the mouth with a small cup of liquid before you will have any pain relief

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

Take time to relax. Practicing some sort of daily relaxation technique--be it yoga, meditation, stretching or positive imagery--is a proven way to manage stress and relieve angina pain, says Dr. Ornish. "Which method you choose is less important than doing it regularly."

Dr. Ornish doesn't think classes in relaxation techniques are necessary for everyone. "A good book or tape can teach you what you need to know," he says, "but a class can be very helpful."