Angina Pectoris Meaning, Causes, Symptoms, Treatment, Ayurveda Concept

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Angina Pectoris means ‘chest pain’ or ‘chest discomfort’. This condition occurs when a part of your heart does not get enough oxygen and blood. Most often it is just called ‘angina’. It can also occur as a symptom of coronary artery disease and may also be caused due to various other etiological factors. It is also called ‘stable angina’.

It usually causes fullness, uncomfortable pressure, squeezing or pain in the centre of the chest. The discomfort may also be felt in your neck, shoulder, jaw, back or arm.
Read – Ayurvedic Heart Care And Treatment For Cardiac Disorders

Causes

Ischemia – inadequate supply of blood and oxygen to the heart muscles is the main cause of angina pectoris. This happens due to narrowing or blockage of arteries of the heart.
Coronary Artery Disease (CAD) – Angina Pectoris can be a symptom of CAD. This happens when the arteries carrying blood to heart either gets blocked or narrowed.
This can occur due to one of the below mentioned causes –

• Atherosclerosis – hardening of the arteries
• Clot formation in the arteries
• Unstable plaque – plaque formed in an artery which can rupture
• Spasm of coronary artery
• Narrowed heart valve and consequent poor blood flow through it
• Decreased pumping of the heart muscles
  Read – Hypercholesterolemia: Ayurvedic Perspective And Pathophysiology

Other types of Angina Pectoris
Micro-vascular Angina – Previously this condition was called as Syndrome X. In this condition the chest pain occurs in spite of absence of coronary artery blockage. The pain is caused from poor functioning of small blood vessels that supply blood to the heart, arms and legs. This condition is more common in women.

Variant Angina Pectoris / Prinzmetal’s Angina – This is a rare condition. It doesn’t occur after exercise or stress. It almost occurs only at rest. It can be very painful and usually occurs between midnight and morning. This condition is also common in women and is related to spasm of the artery.
Read – Hrid Roga: Causes, Types, Symptoms of Heart Disease As Per Ayurveda

Risk Factors

Angina is caused by anything that enhances the demand of more blood and oxygen for the heart muscles, especially if the person has a blockage or narrowing in the artery already.

• Physical activity
• Emotional stress
• Extreme cold conditions
• Extreme hot conditions
• Smoking cigarettes / addiction
• Consumption of too much alcohol / addiction
  Read – Ayurvedic Smokers Diet – Must Have Herbs In Your Diet

Symptoms

• Chest Pain – Pain in the chest, usually beneath the sternum (breastbone), it may characteristically be of pressing, crushing or squeezing type.
• The chest pain may spread to – arms, shoulders, neck, back or jaw
• Pain may also occur in upper back, neck, both arms or ear lobes

Other symptoms –

• Shortness of breath
• Tiredness / fatigue
• Weakness
• Feeling as if fainting

The pain or discomfort of angina pectoris –

• occurs during physical exertion when the muscles of the heart work heart
• does not suddenly come (as a surprise), episodes of pain tend to be alike
• usually lasts for a short period of time – 5 minutes or less
• relieved either by medicine or rest
• may feel similar to gaseous distension or indigestion
• may feel like chest pain that spreads to the back, arms or other areas of the body

Complications

One may be at increased risk for a heart attack if they have angina. This is due to inadequate blood supply to a part of the heart.

Diagnosis

• Physical and cardiac examination of the patient
• Recording complete medical history of the patient

The symptoms of this condition are typical and will help in diagnosing this condition.

Tests

• ECG – show abnormal rhythms and also detect heart muscle damage
• Stress Test – done as the patient exercises on a treadmill or while pedaling a stationary bike. Helps in checking the heart’s ability to function when under stress / doing exercise. While carrying this test, breathing patterns and blood pressure are also watched and recorded. It is also used to find CAD (coronary artery disease).

Variants

Exercise Treadmill Test only uses an ECG to evaluate for ischemia.
In Stress Echocardiogram ECG and ultrasound pictures of the heart are used for diagnosis.
In nuclear perfusion stress test an ECG and radioactive tracer are used.

• Cardiac Catheterization – X ray images of the arteries are taken after a contrast dye is injected into the arteries. This is done to see the narrowing, blockages and other problems of certain arteries.
• Cardiac MRI – used to see the amount of blood flow to the muscles of the heart.
• Coronary CT scan – helps to see and find out the amount of calcium and plaque inside the heart blood vessels and also to show the blood flow through the arteries around the heart (coronary arteries).

Right time to consult doctor

You need to seek medical attention immediately when you have any one of the below mentioned –

• symptoms of angina that change suddenly (unstable angina)
• symptoms occur when resting
• symptoms of angina continue to be in spite of using nitroglycerin
• symptoms last for longer than usual
• symptoms appear unpredictably

If you experience some of these you might be having a heart attack. You can call the doctor or take help to go to the hospital. You should be careful not to drive yourself to the hospital.

• symptoms of angina get worse
• new symptoms appear
• side effects from the medicines that you are taking

Prevention

• following a healthy diet plan
• indulgence in regular physical activity
• efficiently managing the stress
• keeping away from smoking
• maintaining a healthy weight
• taking medicines as prescribed
• learn how cold and hot weather affects heart and learn to manage health during extremes of cold and heat
• proper and timely treatment of high blood pressure, high cholesterol, excessive weight and diabetes

Treatment

Treatment of angina pectoris is based on the symptoms, age and general health and also on the severity of the condition / symptoms of the patient.

Generally the chest pain or discomfort of angina pectoris is relieved with rest, nitroglycerin or both.

Nitroglycerin is the most common medicine used for this condition. This helps in widening your blood vessels and relieves pain related to angina. This will eventually increase blood flow to the heart muscle and decreases the workload of the heart. Long-acting nitroglycerin helps in preventing angina. It can also be used in the form of nasal spray or as sublingual (beneath your tongue) medication when pain of angina occurs.

Beta-blockers and calcium channel blockers are also used to treat angina.

If you have stable angina and start getting chest pain more often and more easily you might have to see your doctor at the earliest. These may be the earlier signs of unstable angina.

Living and coping up with angina pectoris

You need to know everything about angina especially if you are suffering from it. You have to note down the patterns of the symptoms, nature of pain, duration of pain, relieving and aggravating factors and the causes which bring about the pain.

Ideal things you can do –

• Call your doctor immediately when you experience the symptoms.
• Work with your doctor to treat the CAD which causes pain related to angina.
• Control risk factors
• Take medicines as prescribed and directed.

Researches

A study has shown that the presence of angina pectoris is associated with psychological distress. (Read more)

Another study shows the global data and predicts that the diagnosed prevalent cases of angina pectoris is expected to reach 22.79 million in 2028. (Read more)

Yet another study suggests how a simple MRI scan can help doctors diagnose patients with angina sparing them from invasive procedures and an overnight stay in the hospital.
(Read more)

Ayurveda Concept of Angina Pectoris

Angina Pectoris has been compared to Hrt Shula explained by Master Sushruta.
Some authors compare it to Vataja Hrdroga explained by Master Sushruta, a type of heart disease caused by predominant aggravation of vata and subsequent affliction of heart by vata. Even in Vataja Hrdroga pain in the region of the heart is the predominant symptom.

Symptoms of Vataja Hrdroga include pulling, crushing, churning, splitting / tearing, blasting or tearing types of pain. Such various kinds of pain have also been mentioned in the explanation of symptoms of angina pectoris. But the symptoms similar to those of vataja hrdroga are also found in coronary thrombosis. Therefore it is more precise to compare angina pectoris to hrtshula. From Ayurveda perspective, angina pectoris shall be treated on the lines of hrtshula or vataja hrdroga.

Ayurvedic Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Hrit Shula (Shoola) means pain in the heart. Hrit Shula is one among the different kinds of shula explained by Master Sushruta. Hrit = heart, Shula = pain / colic

Causes

Kapha Pitta Prakopaka Mithya Ahara Vihara – incompatible foods and life activities which bring about aggravation of kapha and pitta are said to be the main causes for the causation of Hrit Shoola.
Read – Shoola Types, Symptoms, Treatment, Medicines, Remedies

Pathogenesis

• Kapha and Pitta get aggravated due to consumption of incompatible foods and exposure to life activities which tend to aggravate kapha and pitta
• The aggravated kapha and pitta cause obstruction of vata
• This vata obstructed by aggravated kapha and pitta gets admixed with rasa i.e. nutritive juice / lymph, enters the heart and gets lodged therein
• This vata on getting lodged in the heart causes pain in the heart
• Due to the pain caused by vata in the heart, the patient finds difficulty in expiration (to breathe out)
• This painful condition is called as Hrit Shula. This condition is caused by combined effect of essence of food formed after digestion of food and vata.
  Read – How To Balance Pitta Kapha Dosha? 6 Factors To Consider

Symptoms

Hrt Shula – Pain in the heart / chest / region of heart
Uchchvasa rodhakam – obstruction to breathing, mainly difficulty in expiration

Are Hridroga and Hrit Shula same conditions?
Hrid Roga means heart disorders. So the term defines different kinds of heart diseases rather than a single condition. They are of five types.
Hrit Shoola is just a painful condition in the region of the heart and there are no subtypes of this condition. In fact Hrit Shula itself is a type of shula elaborated by Master Sushruta. Hridroga is explained as a separate entity.

Hridroga also manifests from different sets of etiological factors, has a different pathogenesis, presents different signs and symptoms depending on dosha involved in the causation and which type of disease has been manifested, has different prognosis and different treatment. Therefore Hrit Shula is different from Hrid Roga. But Master Sushruta has directed to implement the treatment of hrd roga in the treatment of hrt shula.

Sanskrit Verses

Modern Correlation

The pain of Hrit Shula can be compared to a modern condition known as Angina Pectoris.

Angina Pectoris is a ‘chest pain’ or ‘chest discomfort’. It occurs when a part of the heart does not receive enough oxygen and blood. It is also called ‘angina’. It can also be a symptom of CAD (coronary artery disease). It may also be caused by other etiological factors. The patient may experience squeezing, pressure, heaviness or tightness in the chest.
Read – Ayurvedic Heart Care And Treatment For Cardiac Disorders

Treatment

Hrid Roga Chikitsa – Hrit Shula shall be treated on the lines of treating ‘Hrid Roga’ i.e. heart disorders.
Vataja Hrid Roga Chikitsa – Though Hrid Roga means ‘group of heart disorders’ the symptoms of hrid roga of vata origin will have similar symptoms to those of hrit shula. In both conditions pain in the chest / region of the heart is common. Therefore hrit shula shall be treated on the lines of vataja hrid roga treatment.
Snehana, Vamana – Initially medicated fats should be given for oral consumption and once the signs of saturation are found therapeutic emesis should be administered. For emesis Dashamula Kashayam mixed with oil or ghee and rock salt shall be used.

Formulations

Sringi Bhasma mixed with ghee
Abhraka Bhasma
Arjuna Churna
Arjuna Ghrta
Arjunarishta

Application of –
Paste of Sringi Bhasma
Narayana Taila
Vishagarbha Taila
Lakshadi Taila
Karpuradi Taila

Causative factors shall be avoided. Dietetic regimen and lifestyle changes as indicated in hrid roga shall be adopted.

Yogas From Sahasra Yoga Text Book

Tiktaka Ghrita
Mahatiktaka Ghrita
Panchatiktaka Guggulu Ghrita
Vrisha Ghrita
Sudarsana Choorna
Tugadi Choorna
Patoladi choorna
Yavanyadi Choorna
Talisapatradi Choorna
Trilavana Pasugandhadi Choorna
Hingu Vachadi Choorna
Vyoshadi Choorna
Karpooradi Choorna
Bala Soolari choorna
Sudha Khandadi Kshara
Dathryarishta
Lohasava
Agasthya Rasayana
Danti Haritakyavaleha
Vyaghryadi Leha
Gandira Rasayana
Swadamshtradi Ghrita
Amrtaprasa Ghrita
Hridrogahara Kashaya
Pushkarahvadi Kashaya
Vilan Veradi Kashaya
Trayantyadi Kashaya

Click to Consult Dr Raghuram Y.S. MD (Ayu)

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