Herbal Health
Herbal Remedies Blog
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DRUGS FOR ANGINA: BETA-BLOCKERS
Research demonstrates that beta-blockers are considered first-line therapy in most patients with chronic angina and prolong life in patients who have had a heart attack.
Beta-blockers prevent angina by lowering the oxygen needs of the heart during physical exertion or emotional stress. They do this by reducing the heart rate, the force of heart muscle contraction, and blood pressure. Your heart rate may fall as low as fifty beats per minute, and if you feel well at that rate, the medicine is acting just as it should.
In the U.S., propranolol (Inderal), atenolol (Tenormin), and nadolol (Corgard) are the most frequently used beta-blockers for angina. They are not used for Prinzmetal’s angina because they tend to increase spasm when it is the cause of angina rather than lessen it.
Patients with asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes, heart failure, or depression need special evaluation before they use beta-blockers. Symptoms can be exacerbated on these drugs. Even without such coexisting conditions some people find beta-blockers hard to tolerate. They may experience side effects such as impotence, bad dreams, cold hands and feet, and fatigue. If you decide beta-blockers are not for you despite their proven effectiveness, do not stop taking them abruptly. You might get “rebound angina.” Talk it over with your doctor, who will decide what is best for you.
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General health General health
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FACTS WHICH AIM TO DISSUADE YOU FROM THE USE OF TOBACCO
So the rest of this article aims to dissuade you from the use of tobacco for the rest of your life. Consider the following facts:
• Heart attacks are the inevitable end of the road for an angina sufferer who continues to smoke.
• Smoking causes almost as many deaths from heart attacks than it does deaths from any other cause, including chronic bronchitis and lung cancer.
• People who smoke cigarettes have two or three times the risk of a fatal heart attack than nonsmokers. The more they smoke, the greater the risk.
• Men under forty-five who smoke twenty-five or more cigarettes a day have ten to fifteen times the chance of dying from a heart attack than nonsmokers.
• In developed countries like the U.S., one-third of men who smoke die before they reach sixty-five, mainly from smoking-related diseases.
• One-third of all women married to smokers are widows before they can enjoy retirement with their husbands, mainly because their husbands smoked.
• About 40 percent of all heavy smokers die before they reach sixty-five. Of the 60 percent of smokers still alive at that age, many are disabled by bronchitis, angina, heart failure, or because they have had a leg amputated.
• Of all smokers, only 10 percent reach seventy-five years of age. Most nonsmokers reach age seventy-five in good health.
• Smoking takes a terrible toll in ways other than heart attacks. In the U.S., smoking accounts for one out of every six deaths. Over 130,000 of these deaths are due to smoking-related cancers. Even passive smoking can be life threatening; it causes an estimated 3800 deaths in nonsmokers each year due to lung cancer.
• Lung cancer has replaced breast cancer as the cancer causing most deaths in women.
• Smoking during pregnancy is responsible for approximately 18 percent of all cases of low birth weight, shortened gestation, and sudden infant death syndrome.
• Other cancers more common in smokers than in nonsmokers include tumors of the tongue, throat, larynx, pancreas, kidney, bladder, and cervix. About one-third of all cancers are caused directly by smoking.
• Don’t think that because you have angina, you won’t get one of these other smoking-related diseases as well. Many smokers have multiple diseases, all caused by their love for cigarettes.
So take stock now if you have angina and you still smoke. You can’t use the false hope of so many people when they face the future “It may not happen to me”—because it has happened to you! You have already been damaged by your habit, and you can be damaged far more if you continue. Nor should you use the excuses heard by every doctor. They are listed here, with their honest answers:
• My father/grandfather/uncle smoked twenty a day and lived until he was seventy-five.
Everyone knows someone like that. But they forget all the others they knew who died long before their time. The chances are, if you continue to smoke, that you will be one of them, and not one of the very few survivors.
• People who don’t smoke also have angina.
True, there are other causes of heart attacks, but 70 percent of all people under sixty-five years old admitted to coronary care units with heart attacks are smokers, as are 91 percent of patients considered for bypass surgery.
• Moderation in all things is acceptable; I only smoke moderately.
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General health General health
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ANGINA/REDUCING THE RISK FACTORS: EATING BETTER
At the same time, start on your long-term plan to reverse your angina. There is not yet hard proof that human beings can reverse already established atheromatous plaques in their arteries by changing their lifestyles, but it seems reasonable to infer, from all the evidence of animal and human volunteer studies, that it can be done. And there is good evidence, from angiogram studies, that a better lifestyle can prevent the development of new plaques.
The best way to change is to convert to an eating pattern that you really like, and can enthuse about for the rest of your life. That is not so difficult as it seems, for the Mediterranean style of eating espoused by Professor Oliver (described in chapter 4) is delicious, as well as healthy and relatively cheap!
The main aim of the new life you must lead is to lower your blood cholesterol level. Cholesterol reaches the bloodstream from two sources: your food (as in eggs or liver), and from your own liver, which makes cholesterol from the fats (mainly animal fats) eaten in food. The cholesterol consumed in eggs and liver is much less important than animal fats as a source of your blood cholesterol, so that you can eat two to three eggs a week or liver once a week, if you like these foods, without worry. Labeling foods as “cholesterol-free” is just a gimmick.
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General health General health
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RISK FACTORS FOR ANGINA
Age
Over all, among the 7,735 men in the British Regional Heart Study, the heart attack rate was 6.2 per 1,000 men per year. The rate was 2 per 1,000 per year for the forty to forty-four year-olds, gradually rising to 10 per 1,000 per year in the fifty-five to fifty-nine year-olds. Forty percent of the cases were fatal, and about half of the deaths happened within an hour of the start of the chest pain. These results were a major stimulus to today’s coronary care service. Suffice it to say that many lives are now saved by the emergency ambulance service paramedics who aim to reach every reported chest pain within fifteen minutes with full emergency equipment on board.
Although ex-smokers in the British Regional Heart Study still retained twice the risk of a heart attack than those who never smoked, stopping did reduce the chances of an attack. Smokers were at much higher risk of a heart attack than nonsmokers and ex-smokers.
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General health General health
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PATTERNS OF ANGINA: DIANE
Diane was forty-one when her coronary disease was discovered—and she had no pain at all. She had had diabetes since she was a child, for which she had to self-inject insulin three times a day. There was a time in her teenage years when she “went a little wild” and let her control slip—a natural reaction at that age to the restrictions of diabetes. However, for the last twenty years she had kept her diabetes under reasonable control.
In the last year or so, though, Diane hadn’t been feeling well, especially when trying to look after her two children. Like many career women today, she started her family late, so that her two boys, aged six and four, are quite a handful.
As with many women with diabetes who become pregnant in their thirties, Diane had a difficult time. Her diabetes was hard to control, particularly near the end of each pregnancy, and the effort of bringing up the two children exhausted her. Her husband shared the work with her, but he eventually convinced her to see her doctor when it was obvious that she couldn’t cope.
The story of exhaustion alerted Diane’s doctors. Most women are protected from the effects of heart disease during their reproductive years by their hormones. The monthly cycle of hormonal changes in some way (we do not yet know how) postpones the onset of heart disease in women, and it is only after menopause that they seem to develop this disease. However, the exception is in women with diabetes. Diabetes appears to neutralize the protective effect of the female hormones, so that women with diabetes are at just as much risk of angina as men of the same age.
There is, however, one striking difference. Angina in women with diabetes is often painless. With diabetes comes a condition called diabetic cardiac neuropathy. The name simply means that, in diabetes, the nerves that convey pain to the brain from the heart are altered. The nerves no longer relay the sensation of pain, so that angina is “silent.”
The lack of oxygen is not perceived as pain, but it may appear instead as a general malaise or simply exhaustion.
This was the case for Diane. An angiogram showed that she, like the first patient, Jim, had several narrowed segments in all three main coronary arteries. She was given a priority waiting-list place for bypass surgery, and was called in for surgery a month later. However, she was also referred to her specialist in diabetes for intensive control of her glucose and insulin levels, so that she would be as fit as possible for the operation.
The surgery was a great success. When coronary artery bypass surgery was first started in the early 1970s, there were doubts about whether people with diabetes would do as well as nondiabetics. These doubts have now been dispelled, following the analysis of the results of large series of patients (in which around one in ten have had diabetes). Through surgery, angina can be considerably improved, whether it is silent or painful, in people with diabetes.
The surgery was not the only change in Diane’s life. She now has a much better lifestyle: She eats smaller meals at shorter intervals than before, and combines them with a different schedule of insulin injections, with the aim of keeping both her insulin and glucose levels as normal as possible throughout the day and night. She also has her blood pressure checked regularly, which is maintained at the lower limit of normal.
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General health General health