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- ANGINA PECTORIS
- "The complete or nearly complete prevention of angina attacks is the usual and expected result of treatment with alpha tocopherol." -- Dr. Wilfrid E. Shute, M. D., Cardiologist who treated over 30,000 heart patients during his career.
TYPICALLY AN ATTACK OF ANGINA pectoris is described by the patient as a sensation of pressure, tightness, or heaviness behind the breastbone. It may become crushing in nature like a closing vise and may be very severe indeed. It can come on so suddenly that it seems instantaneous, with the victim suddenly subjected to unbearable pain that renders him unable even to walk. The attack can end quickly or can continue until it is treated. The pain has a tendency to radiate, usually to the left shoulder and arm all the way down to the fingers. It is often accompanied by great anxiety and a fear of impending death. A mild attack, however, may occur simply as a sensation of pressure within the chest. . .
Characteristically, true angina pectoris is elicited when the oxygen demand is increased, which can occur because of excitement, exertion, or even after the eating of a heavy meal. However, intercostal pain may also be elicited by exertion, since an increased rate of respiration and greater movement of the chest may irritate the affected nerve, but it can also result from any change in position and frequently occurs while the patient is sitting in a chair or lying in bed, whereas true angina does not occur when the patient is at rest.
Although it had long been supposed, because angina attacks are so frequently brought on by exercise, that the syndrome resulted from insufficient oxygen supply to the heart, it was first demonstrated in 1984 when Dr. Lawrence S. Cohen of Harvard Medical School and Peter Bent Brigham Hospital found an excess of lactic acid in the heart muscle during angina attacks. Since the consistently high quantities of lactate could only have been produced in the absence of oxygen, the findings represented a remarkably clean and uncomplicated demonstration of hypoxia, as reported to the Thirteenth Annual Convention of the American College of Cardiology in New Orleans.
Since then it has gone almost unquestioned that angina is caused by oxygen lack, which knowledge should have provided the key to a treatment that would be more than palliative. Tile characteristics of such a treatment had become obvious. For example, it was possible for a paper in the New England Journal of Medicine (December 14, 1987, page 1,278) to commence with, "Because angina pectoris is a consequence of inadequate myocardial oxygenation, ideal therapy for this incapacitating symptom would be directed toward both increasing coronary blood flow and decreasing myocardial oxygen requirements."
The authors, Dr. Braunwald, Epstein, Click, Wechsler, and Braunwald, might just as well have gone on to name alpha tocopherol as their ideal therapy if these National Heart Insitute doctors had only known it.
It has already been pointed out in the chapter on coronary occlusion that alpha tocopherol simultaneously is a powerful fibrinolytic agent, with an action that causes arterial blood clots to disintegrate, and a vasodilator that will increase the blood supply to the heart by widening the arterial lumen.
It also plays a third and equally significant role in its function, well known to food technicians everywhere, as an antioxidant.
When it is pointed out that the consumption of polyunsaturated fats reduces the serum level of vitamin E and increases the likelihood of vitamin E deficiency, that is an expression of the consequence of vitamin E's antioxidant activity. Ordinarily the essential fatty acids released into the bloodstream by polyunsaturates are highly vulnerable to per-oxidation - linking their molecules one for one with molecules of oxygen. Vitamin E in the bloodstream, however, preferentially bonds with the fatty acids and prevents their oxidation. The vitamin E is destroyed in the course of this activity, which is why polyunsaturates in the diet in any quantity create a need for proportionately more of the vitamin. But by this antioxidant activity, the vitamin prevents oxygen from being converted into toxic peroxides, leaving the red cells of the blood more fully supplied with pure oxygen that the blood carries to the heart as well as other organs.
By all these properties already existing in one drug - and - that drug virtually without side effects except through overdosage in very special cases - surely this drug, alpha tocopherol, is as well tailored to be the ideal therapy for angina as any material could possibly be.
Unfortunately, alpha tocopherol remains largely unknown to the medical profession, and as a consequence the profession has wasted a frantic 20 years of search for a drug that already exists. Untold time and money have been spent in the development of amyl Nitrite, erythrityl tetranitrate, pentaerytlrritol Tetranitrate, and others in a long list of nitrates and nitrites, Iproniazid, and other monoamine-oxidase inhibitors. The result is usually a short-lived fad and a quick return to nitroglycerin, which has no therapeutic effect whatsoever, but is remarkably fast and effective in relieving an attack of angina.
So after years and years of search for a drug that would treat angina, the choice available to today's doctor is still to use the brown nitroglycerin tablets that have a chocolate base or the white tablets with a sugar base.
To the patient accustomed to walking around with a pocket full of nitroglycerin tablets and perhaps taking as many as 20 to 30 tablets a day, it could in no way represent a burden to take a few vitamin E capsules daily thus preventing the recurrence of angina attacks in most cases, and to be able to throw away the nitroglycerin
The complete or nearly complete prevention of angina attacks is the usual and expected result of treatment with alpha tocopherol. Angina patients are treated exactly like those who suffer the same symptoms upon recovery from a coronary occlusion. The results are comparable in every way, except that I have a vague impression that, on the whole, patients who have had a frank coronary occlusion respond somewhat better I don't know why.
It is essential to recall that two investigators, after years of careful study of the available material and evidence, stated that in their opinion all patients who had developed angina pectoris had had a coronary occlusion, though usually of a small vessel so that the electrocardiographic changes were not diagnostic or were easily missed, if this is so, and I consider it probable, then angina represents a specific indication for preventive measures against the possibility of thrombosis.
Unless there is some contraindication, such as hypertension, an angina patient is routinely started by me on 800 international units of alpha tocopherol a day and seen at intervals of six weeks for reassessment. If no result has been obtained within six weeks, the dosage is increased by 200 to 400 international units for the next six weeks. When we reach the dose on which their symptoms are relieved, it is continued permanently.
Although the protection from a coronary thrombosis in these patients is very nearly universal, it sometimes happens that, after some years, the symptoms of angina recur. In such a case, it is necessary once again to increase the (lose gradually and keep increasing it until the condition is relieved.
In discussing the successful treatment for angina, however, it must be re-emphasized that a misdiagnosis can easily be made.
There is one type of pain, which is very common in middle-aged or older people which is very commonly mistaken for angina pectoris. It has been given many different names, by many different authors, although recognized as a definite entity for years. Also, the site of the responsible lesion has been identified in different locations - the sterno-costal joint, the intercostal nerve itself, or the nerve root. To make matters more confusing, it can be on either side at any level and so the pain can be ascribed to referred pain from several different organs. The most common name for this condition is intercostal neuralgia or intercostal neuritis, and so the inference is that it is a definite lesion of the intercostal nerve. It is often referred to as a radiculitis, signifying a lesion in the nerve root. It has been called the rib syndrome. It has been often misdiagnosed as breast tumor, cholecystitis, etc.
This pain nearly always occurs in the left upper chest in front in right-handed people and in the upper right chest in front in left-handed people. In fact, this is so usually the location and so typically right or left sided, that once the patient has described it you can confidently tell him whether he is right or left handed. Characteristic of this pain is that it occurs toward the front of the chest; but it is accompanied by marked tenderness between the ribs, and this tenderness can be followed all the way around in the intercostal space right to the lateral aspects of the spine. The patient may not be aware of the tenderness until the doctor puts pressure on the area.
The author has seen hundreds of such cases, many of which have had the condition for years. There has been no very effective medical treatment available for this condition, and the author has developed his own theories and method of treatment which are very effective in nearly all - but not all - cases.
The doctor of medicine has been taught for years that minor dislocations of joints or their immobilization in an abnormal part of their range of movement cannot occur.
Therefore, the chiropractic and osteopathic approach to pain was considered necessarily based on incorrect theory and manipulation of no greater benefit than heat and massage. All this, too, has changed, and the president of the American College of Surgeons and, now, many others have attested to the value of correct manipulation in treating many joint lesions. The author has known this for 24 years. He discovered three osteopaths who could relieve chest pain of this type in most patients, often very dramatically. In one such case a man who couldn't walk 20 yards, without pain, after manipulation walked for miles up and down hill and through college grounds and climaxed it by running upstairs, where he arrived breathless and perspiring, but free of pain.
However, again by chance, a most effective medical treatment for this condition was discovered. While investigating the possible usefulness of vitamin E ointment (30 I.U. alpha tocopherol per gram of petroleum jelly), Burgess and Pritchard of the Montreal General Hospital had demonstrated its usefulness in hastening the healing of indolent ulcers and in so doing had shown that the alpha tocopherol in the ointment was absorbed by the tissues under the skin right down to the periosteum of bone. It literally walks right through the skin as if it weren't there. Now we treat all such patients by the inunction of vitamin E ointment into the skin over the nerve root for ten minutes, followed by heat for another ten minutes to drive in still more alpha tocopherol This works miracles in one to three nights. If it doesn't work within this three-day interval, we send the patient to the osteopath - not just any osteopath, of course - and if this doesn't get the desired result, we use vitamin B, hypodermically and by mouth, but with little hope that it will be successful.
Having excluded referred pain from organs and having excluded intercostal nerve pain, presumably pain that occurs in the chest on exertion or excitement (especially after a heavy meal or soon after the oxygen reserve in the heart muscle has been used up during sleep or after exertion just before elicitation of pain) is due to coronary artery narrowing and resulting myocardial anoxia.
A word is necessary about status anginosis, a condition of nearly continuous angina pectoris even at rest. In 30,000 cases, I've never seen one. I've seen patients in such deep failure that they couldn't move about at all - but no status anginosis. Early in our London, Ontario, days a patient of my brother's, an obstetrician was seen in consultation while in the hospital at her daughter's request. She was there because of the diagnosis of status anginosis made by the internist to whom she had been sent by her family physician. My brother elicited the typical intercostal tenderness in the appropriate segment and suggested vitamin E ointment and heat as described in this chapter. She was completely cured of her status anginosis overnight.
Like all our coronary patients, angina patients are urged to lead normal lives, as far as this is possible. We restrict them in only two ways. We ask that they don't try to show anyone how much they can lift or how fast they can run. Many patients have returned to hard manual laboring on farms and in factories without subsequent trouble.
There is even a distinct possibility that such hard work does them good - as long as they are protected against sudden insufficiency by vitamin E saturation. It was reported by Doctors Smith and Kidera in Aerospace Medicine (38:742, July, 1967) that physical stress is beneficial in some cases of angina, because it helps the development of collateral circulation. A gradually extended exercise program leading up to an objective of jogging a mile in 20 minutes showed excellent results in 15 cases and poor results in six.
The poor results, of course, were in dyspnea and early congestive failure. They could have been avoided.
(from "Vitamin E for Ailing and Healthy Hearts," by Wilfrid E. Shute, M. D. with Harold J. Taub, Pyramid House, N. Y., 1969, pp 43-49).
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