Essentially, angina is a muscle cramp in the heart—the one muscle that cannot take a rest. It develops when the heart muscle does not receive enough oxygen for its needs from the arteries that supply it: the coronary arteries. Angina is, therefore, a symptom of coronary artery disease. Atherosclerosis is the most common cause of coronary artery disease; it causes thickened arterial walls and impaired blood flow.

People usually experience angina as a squeezing chest pain, as if a heavy weight rested on the chest or a tight band wrapped around it. This is often accompanied by sweating, shortness of breath, and possibly pain radiating into the left arm or neck. Usually, angina is brought on by exercise—the more rapidly the heart pumps, the more oxygen it needs. Atherosclerosis (hardening of the arteries) is the most common cause of angina.

People with angina are at high risk for a heart attack, and treatment must take that into account. Drugs that expand (dilate) the heart's arteries, such as nitroglycerin, can give immediate relief. Other drugs help over the long-term by making the heart's work easier. It is also important to slow or reverse the progression of atherosclerosis by treating high blood pressure and high cholesterol and by reducing other risk factors. Surgical treatments (such as angioplasty and coronary artery bypass grafting) physically widen the blood vessels that feed the heart.

Angina is a serious disease that absolutely requires conventional medical evaluation and supervision. No one should self-treat for angina. However, alternative treatments may provide a useful adjunct to standard medical care when monitored by an appropriate healthcare professional. We intentionally do not give dosages in this section as they should be individualized by your doctor; however, you can find general guidelines in the separate articles on each substance.

Note: Because angina is usually caused by atherosclerosis, other relevant information may be found in the Atherosclerosis article.

L-Carnitine

The vitamin-like substance L-carnitine might be a good addition to standard therapy for angina. Carnitine plays a role in the cellular production of energy. Although carnitine does not address the cause of angina, it appears to help the heart produce energy more efficiently, thereby enabling it to get by with less oxygen.

In one controlled study, 200 individuals with angina (the exercise-induced variety) received either a daily dose of L-carnitine or were left untreated.1  All the study participants continued to take their usual medication for angina. Those taking carnitine showed improvement in several measures of heart function, including a significantly greater ability to exercise without chest pain. They were also able to reduce the dosage of some of their heart medications (under medical supervision) as their symptoms decreased.

Unfortunately, the results of this study can't be fully trusted because it didn't use a double-blind, placebo-controlled  design. (For information on why double studies are so important, see Why Does This Database Rely on Double-blind Studies?) A smaller trial that did use a double-blind, placebo-controlled format evaluated 52 people with angina.2 The results showed that daily use of L-carnitine significantly improved symptoms as compared to placebo.

Other studies (both single- and double-blind) used a special form of L-carnitine called L-propionyl-carnitine, and researchers found evidence of benefit.3-6 Consult with your physician regarding dosage and specific safety issues.

For more information, including dosage and safety issues, see the full L-carnitine article.

Magnesium

Magnesium has actions in the body that resemble those of drugs in the calcium channel blocker family, although much weaker. Since these drugs are useful for angina, magnesium has been tried as well.

In a 6-month, double-blind, placebo-controlled study, 187 individuals with angina were given either daily oral magnesium or placebo.17 The results showed that use of magnesium significantly improved exercise capacity, lessened exercise-induced chest pain, and improved general quality of life.

Similarly, two double-blind, placebo-controlled studies, enrolling a total of about 100 people with coronary artery disease found that supplementation with magnesium significantly improved exercise tolerance.18,24

For more information, including dosage and safety issues, see the full Magnesium article.