Chronic Refractory Angina

Relaxation

This is a very simple approach that nearly always leads to some improvement and can be highly effective in some patients especially those in whom angina provokes feelings of anxiety. It is important to explain that recommending relaxation does not mean that the doctor thinks that the problem is "all in the patients head". It is simply acknowledging that nature has has been gradually producing a system that invariably releases adrenaline whenever it encounters or even perceives a problem. Almost all refractory angina sufferers will agree that "stress" in all its forms makes the angina worse and many have already learned behavioural responses that minimise stress. One of the consequences of adrenaline release in response to the pain of myocardial ischaemia is a feeling of anxiety and coupled with an understandable anxiety that many patients experience if they believe that "this one might be the one that kills me" can produce a panic attack. Slow breathing combined with relaxation tells the system that it is not under imminent attack and that it should stop releasing adrenaline. Thus the basis of relaxation is to control the bodies fundamental urge to throw petrol on the fire. The sooner the patient stops throwing petrol during an attack the better.
Even the simplest techniques require training. In its simplest form patients are told to stop whatever has provoked the episode, remember that although it is a nuisance angina is natures way of telling you that your heart is growing new blood vessels. Next breathe in over 3 seconds, pause and breathe out over 5 seconds. At the end of breathing out relax a muscle group, e.g. the shoulders. Then repeat the process relaxing more muscle groups each breath. Some people prefer to start at the feet and systematically work through one group of leg muscles then the other always remembering to check that muscles are fully relaxed.
It is quite difficult to learn to do this during an episode of pain so patients are told to learn the technique under the least stressful conditions i.e. not in pain,  in a quiet room, comfortable chair with gentle background music. Once the patient has mastered the technique then it can be applied during painful or stressful episodes.

The effect of others

It is very difficult to relax if people nearby are anxious. It must be remembered that we have evolved to sense danger and we are very good at recognising signals of anxiety in others. There is not much point in the patient getting his/her body to tell that arousal centre that it is not in danger when the ears and eyes are saying the opposite. Therefore it is important that both the patient and the main carer(s) learn the technique so that both can apply it during an attack.

(Go to stress and angina)
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