Angina is chest pain caused by coronary heart disease, a partial blockage of the coronary arteries. If you have angina, your heart may not get enough blood, especially when you exercise or are under stress. If you have chest pain when you are resting, or the pain doesn't go away after a few minutes, call 911 or your local emergency number. You may be having a heart attack.

• Pressing or squeezing pain in the chest
• Pain lessens in a few minutes when you rest or take medication prescribed by your health care provider

Coronary heart disease is the root cause of angina. Some risk factors for developing angina are older age, male sex, menopause, family history of angina, diabetes, smoking, high cholesterol, high blood pressure, obesity, sedentary lifestyle, and stress.

You will have an electrocardiogram (EKG), during which electrodes will be fastened to your chest with a sticky gel. Your health care provider may also suggest a stress test, in which the EKG is taken while you walk on a treadmill or use a stationary bicycle. Your health care provider may recommend coronary arteriography, where a catheter is inserted through a small incision to inject a dye that makes your blood flow visible on an x-ray image. Any blockages in and around your heart will appear.

There are two main goals in treating angina. The first is to allow you to perform moderate exercise without pain. The second is to treat the underlying heart disease and prevent it from getting worse.

• Nitrates—increase the size of blood vessels, thus allowing blood to flow more easily; also help beta-blockers and calcium-channel blockers to work more effectively; tolerance occurs with continued use
• Beta-blockers—used for angina symptoms; reduce blood pressure, heart rate, and the force by which the heart pumps blood; serious side effects if medication is stopped suddenly
• Calcium-channel blockers—used for angina symptoms; reduce blood pressure and the force by which the heart pumps blood; some also reduce heart rate
• Cholesterol-lowering medications—slows blockage of arteries

• Aspirin—allows blood to flow more easily

If drugs are ineffective, you may need surgery. There are many different types of surgery to remove blockages from blood vessels or widen blood vessels so blood flows more easily.

Specific herbs and nutrients can help treat angina.

Avoid saturated fats (meat and full-fat dairy products), refined foods, caffeine, and alcohol. Eat more fresh vegetables, whole grains, and essential fatty acids (cold-water fish, nuts, and seeds).

The following supplements may help reduce symptoms of angina by strengthening heart muscle, lowering cholesterol, supporting connective tissue, and helping blood cells function normally.

• Coenzyme Q10 (50 to 100 mg one to two times per day)

L-carnitine (330 mg two to three times per day)

• Vitamin E (400 to 800 IU per day)
• Essential fatty acids (1,000 to 1,500 mg one to two times a day)
• L-taurine (100 mg twice a day) and magnesium (200 mg two to three times per day)
• Vitamin C (250 to 500 mg two times per day)
• Bromelain (400 to 1,000 mg per day)

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. of herb per cup of hot water. Steep, covered, 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Hawthorn (Crataegus monogyna), linden flowers (Tilia cordata), and motherwort (Leonorus cardiaca) may be used long-term as teas with a high degree of safety. The rest of the herbs listed here should be used under the supervision of a qualified practitioner because of toxic side effects.

A cardiac tonic that contains herbs to stimulate circulation and strengthen the cardiovascular system includes hawthorn (Crataegus monogyna), ginkgo (Ginkgo biloba), linden flowers (Tilia cordata), mistletoe (Viscum album), Indian tobacco (Lobelia inflata), and motherwort (Leonurus cardiaca). A tincture made from equal parts of these herbs should be taken in 20 drops three times a day.

For acute relief of symptoms use a tincture made from equal parts of the following herbs: yellow jasmine (Gelsemium sempervirens), Indian tobacco (Lobelia inflata), monkshood (Aconite napellus), night-blooming cereus (Selenicereus grandiflorus), and ginger (Zingiber officinale). Take 10 to 20 drops every 15 minutes when necessary, up to eight consecutive doses.

Some of the most common remedies used for angina are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours until your symptoms get better.

• Aconite for panic and fear of death with tachycardia.
• Cactus for constriction in chest, pains down the left arm.
• Glonoine for rapid pulse, violent palpitations, cardiac pains that radiate to arms, and waves of pounding headache.

Acupuncture can relieve symptoms and help treat underlying causes.

Massage can improve circulation to peripheral tissues.

Keep track of what causes your angina pain, what it feels like, how often you get it, and how long it lasts. If there's a change in your pattern, let your health care provider know right away.

Hawthorn, linden, and motherwort are safe during pregnancy. Stronger herbs should not be used without provider supervision.

Ballegard S, et al. Acupuncture in angina pectoris: does acupuncture have a specific effect? J Intern Med. 1991; 229:357-362.

Caligiuri G, et al. Immune system activation follows inflammation in unstable angina: pathogenetic implications. J Am Coll Cardiol. 1998;32:1295-1304.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cohen M, et al. A comparison of low-molecular weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med. 1997;337:447-452.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:58-60.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:40-77.

Zhou XP, Liu JX. Metrological analysis for efficacy of acupuncture on angina pectoris [in Chinese]. Chung-Kuo Chung His I Chieh Ho Tsa Chih. 1993;13:212-214.