Angina (pronounced an-JI-nuh), or severe chest pains that may accompany exertion, is a symptom of impaired circulation affecting the heart and should of course be evaluated and monitored regularly by your physician. Most of the information discussed in our entry on HEART DISEASE is relevant to angina, so we recommend that you consult that part of the book. Here, we will deal specifically with just two of the many aspects of angina.

Although we usually associate angina with periods of unusual e ertion or emotional stress, angina can also strike in the middle of th night, shattering sleep with a painful and terrifying real-life nightmare Digitalis and diuretics are often used to treat such nocturnal angina on the theory that one of the major mechanisms of this disorder is increase in the return of blood from the veins when the body is in supine position. Recently, heart specialists at two medical centers in Israel decided to see what would happen if the entire body was simply tilted slightly during sleep, with the feet down and the head up. Would this simple change in sleeping position affect blood flow enough to make a difference in episodes of nocturnal angina?

To test their theory—which probably seemed too simple to he successful—they selected ten patients between the ages of 45 and 65,who had all been admitted to a hospital to have coronary bypass surgery performed. All the patients had severe unstable angina, with at least 1 episode of pain per night for three nights before the study, and had not responded even to maximum antiangina drug therapy. During the first night of the study, considered the control period, the patients slept on beds positioned so that the head and chest were raised but the rest of (he body was horizontal. During this first night, the patients had anywhere from 2 to 7 episodes of pain each, with a total of 37 pain episodes for the ten patients. Some 48 tablets of the medication isosorbide dinitrate had to be given to control pain.

On the second night, the bed was positioned to be flat but was tilted in such a way that the head of the bed was some 10 degrees higher than the foot. This is called a 10-degree reverse Trendelenburg tilt. Results? As compared to a total of 37 episodes of pain during the control night, there were only 2—a decrease of nearly 95 percent. And As compared to 48 pain pills taken during the control night, only 3 had to be administered when the patients slept in the head-up, feet-down
position.

If you are troubled with nighttime angina, we suggest discussing these findings with your physician. You might want to refer him to an article by Drs. Mohr, Smolinsky and Goor, entitled “Treatment of Nocturnal Angina with Ten-Degree Reverse Trendelenburg Bed Position published in the Lancet, June 12, 1982. With your doctor’s approval, you might want to so some creative carpentering on your own bed.

Tags: a symptom of impaired circulation affecting the heart, chest pains that may accompany exertion, HEART DISEASE

Posted on Tuesday, August 12th, 2008 at 2:35 pm filed under Health.