Angina

What is angina?

Angina (medical name is angina pectoris) is chest pain that happens when the heart does not get an adequate supply of blood (and therefore oxygen).

Angina occurs as a symptom of myocardial ischaemia (also known as coronary artery disease). This occurs when the coronary (heart) arteries that supply blood and oxygen to the heart have an impaired function and that causes the heart to become starved of oxygen, which can make it hurt.

There are three main types of angina:

• Stable angina – this is the most common type of angina. It is brought on by physical exertion and a number of other activities (high emotions, prolonged stress, being in freezing cold temperatures, as well as smoking) and is usually relieved by rest or using angina medication and follows a regular pattern of pain for 1-3 mins (but not longer than 10 mins). This is the least serious form of angina (compared to the other types)
• Unstable angina – irregular pattern of angina and may be brought about by physical exertion or even when just resting. The pain is more frequent, more severe and may last longer (up to 30 mins) and may indicate a heart attack is about to occur. Unstable angina is a serious health condition which needs emergency medical treatment
• Variant angina – also called Prinzmetals angina, is not very common but affects more women than men. The pain occurs without warning, often while resting and even at night and can be caused by cocaine usage

Facts about angina

• Angina is a very common condition – it affects approximately 1 in 50 people
• As many as 1 in 25 people have stable angina
• Angina, while not a serious condition, may signify that a potentially serious heart condition is underlying the pain and should be thoroughly investigated
• Angina can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion
• Having angina increases the risk of having a heart attack
• Angina is due to a temporary reduction in the flow of blood to a part of the heart muscle and will not cause damage to the heart itself
• Variant angina, which causes spasms of the artery walls may be caused by cocaine usage and these spasms may be so severe that they can cause a heart attack
• Variant angina is quite a rare condition and accounts for only 2% of all angina cases
• Angina is known medically as angina pectoris
• Angina is more common in women than in men
• Angina is not a heart attack

Symptoms of angina

Main symptoms of angina are:

• Aching pain across the chest and particularly behind the breastbone
• Breathlessness or a choking feeling
• Feeling sick or exhausted
• Pressure or a squeezing pain in the chest
• Pain may also occur in the shoulders, arms, neck, jaw, or back
• The pain from angina may also feel like indigestion

The pain that angina causes can often radiate to the neck, jaw, arms, back or even the teeth. It affects everyone differently.

Angina symptoms that may signify a serious health threat

People who already have angina should get medical help immediately if they experience any of the following symptoms:

• Being woken in the night by angina symptoms
• Symptoms that are more severe than normal
• Symptoms that occur more often than normal
• Symptoms that last longer than normal

These symptoms may signal that there is a high risk of a heart attack happening very soon.

Causes of angina

Angina is mostly caused by underlying (and sometimes not yet diagnosed) coronary artery disease. Coronary heart disease occurs when there is an accumulation of cholesterol plaque in the coronary arteries, which is called arteriosclerosis.

The coronary arteries supply blood, oxygen and nutrients to the heart and if these arteries are blocked or become narrowed due to heart disease and the heart is not able to get enough oxygen to work properly and the pain of angina ensues.

A less common reason for angina is due to spasms of the coronary arteries, which is due to variant angina. Variant angina can be caused by a number of factors, including cocaine abuse.

Apart from an underlying heart problem, angina can also be caused by any of the following:

• Anaemia
• Cold temperature
• Exercise (especially if it is too vigorous)
• Fast or abnormal heart rhythms (arrhythmia)
• Heavy meals
• Extreme or prolonged emotional stress
• Inflammation or infection of the coronary arteries
• Intense emotional outbursts
• Smoking

Prevention of angina

Non-preventable risk factors

Angina may be unpreventable in certain circumstances:

• Being male – men of all ages seem to have a higher risk for angina
• Being over 50 – people over 50 have a higher risk for developing angina than people who are younger and this is due to the body not functioning as well as it should, especially the cardiovascular and circulatory systems
• Genetics – people who have a family history of angina or any type of heart disease are also at a higher risk for developing angina
• Type 1 diabetes – people with type 1 diabetes are more likely to have angina as well as coronary heart disease due to their high likelihood to have high blood cholesterol and thus atherosclerosis. People with type 2 diabetes also have this risk, but this type of diabetes is known to be able to b prevented through proper diet and exercise

Preventable risk factors

There may be ways to prevent angina from occurring:

• Being overweight – people whose weight is higher than the healthy weight range for their age and height, especially those people who have a high weight circumference (larger than 80cm for women and larger than 94cm for men), have a higher risk for angina and any type of heart disease. maintaining a healthy weight is vital to preventing many types of health conditions, including heart disease and angina. Weight range should be within healthy limits and especially waist measurements should be in a healthy range (less than 80cm for women and less than 94cm for men)
• Drinking too much alcohol – research shows that high intake of alcohol is implicated in a number of health conditions, including heart disease and angina, so only drink in moderation and ensure that a few days are alcohol free each week. Research suggests that any intake of alcohol is significantly associated with a number of cancers and that there is no safe intake level of alcohol, so it is not just the heart that may be at risk
• High blood pressure – people who have high blood pressure (hypertension) also have a higher risk for angina and this is due to the damaging effect that high blood pressure has on the artery walls
• High cholesterol levels – people who have high blood LDL (“bad”) cholesterol levels, have a higher risk for angina and coronary artery disease, because the excess cholesterol may clog up the artery walls, which causes a risk for the condition atherosclerosis and also be a risk factor for a heart attack too
• Not exercising – regular physical activity helps to maintain healthy body weight and also helps to reduce (or even prevent) heart disease, including angina. Regular physical activity is associated with a healthy heart and healthy artery walls (less likely to be clogged with plaque or cholesterol)
• Not having a healthy heart and blood – a healthy heart is less likely to cause any angina symptoms. Keep blood pressure, blood cholesterol and blood triglycerides in a healthy range by ensuring that the diet is full of fresh fruit and vegetables, legumes, wholegrains, nuts and seeds, fish, some red meat and low fat dairy. It is well known that these factors can contribute to a healthier heart, which can reduce likelihood of developing any type of heart condition, including angina
• Not reducing stress – prolonged and unrelenting stress is known to cause angina symptoms and this is because of the increase of stress hormones which may constrict heart arteries and worsening angina. Anger and hostility are known to increase blood pressure. Try to engage in some form of relaxation therapy, such as meditation, yoga or even tai chi, to help reduce the effects of stress
• Smoking – research shows that smoking (even prolonged exposure to second hand smoke) can cause angina as it constricts the arteries, damages the artery walls and enables more plaque to be deposited in the arteries and cause coronary heart disease such as atherosclerosis
• Type 2 diabetes – people with type 2 diabetes, the one which generally develops through obesity and an unhealthy lifestyle, have a much higher risk for developing angina too

Complications of angina

If angina is not diagnosed and treated it could cause some serious complications:

• Heart attack – the most serious complication of angina is a serious one, heart attack. A heart attack may occur due to a number of factors, associated especially with unstable or variant angina, which are the more serious forms of angina and which may result in a heart attack. People with any type of angina need to be monitored and given medication to reduce risk of heart attack

People who already have angina should get medical help immediately if they experience any of the following symptoms:

• Being woken in the night by angina symptoms
• Symptoms that are more severe than normal
• Symptoms that occur more often than normal
• Symptoms that last longer than normal

These symptoms may signal that there is a high risk of a heart attack happening very soon.

When to see a doctor about angina

Anyone who has any of the symptoms of angina should see their doctor to rule out any underlying heart condition, as some types of heart conditions are associated with unstable angina (coronary artery disease) and pose a much higher risk for heart attack. In addition to this, variant angina can be quite serious and needs to be also properly diagnosed and treated.

Anyone who is currently diagnosed with angina, needs to ensure they have regular consultations with their doctor to monitor their condition (especially unstable or variant angina) and their medications. Anyone who has been diagnosed with stable angina and who experiences worsening of symptoms needs to visit their doctor for a consultation, as their condition may become serious.

People who already have angina should get medical help immediately if they experience any of the following symptoms:

• Being woken in the night by angina symptoms
• Symptoms that are more severe than normal
• Symptoms that occur more often than normal
• Symptoms that last longer than normal

These symptoms may signal that there is a high risk of a heart attack happening very soon.

Diagnosis of angina

Initial diagnosis of angina is through the following tests:

• Medical history of symptoms – the doctor will ask a series of questions about the severity and duration of symptoms as well as the onset (start) of symptoms, whether any activity makes symptoms worse and whether or not you smoke cigarettes
• Physical examination – the doctor will do an initial and simple examination of your heart with a stethoscope, to hear if there are any obvious problems with the heart and will test your blood pressure with either a manual or electronic a blood pressure monitor
• Blood test – the initial investigation also usually includes requesting a blood test to determine if the blood cholesterol (both the LDL (“bad”) and HDL (“good”) levels of cholesterol) and triglycerides are too high, which can indicate an underlying heart condition which needs to be treated

Diagnostic tests

Further tests can be requested to confirm diagnosis of angina if initial diagnosis warrants:

• Chest x-ray – an x-ray of the chest cavity showing the heart and lungs can be done to rule out any other underlying health conditions for the cause of the angina
• Coronary angiography – this diagnostic test is the most accurate way to measure the severity and extent of coronary artery disease, but it is a very invasive and costly test that requires a hospital stay to recover. The coronary angiography involves insertion of a thin, long, flexible tube (called a catheter) is into an artery in the forearm or groin which is then guided towards the heart with the special camera that is at the end of the catheter (and the images can be viewed on a special monitor to help with guidance). Once the catheter is in the right place (near where the coronary artery blockage or narrowing is suspected to be), a special contrast fluid (which can be viewed on the x-ray monitor) is injected into the catheter to show blood flow inside the coronary arteries and to identify any areas that are narrow or blocked. A coronary angiography usually takes about 30-60 minutes and is done without sedation (although a sedative will be given about an hour before the procedure to help relax you, but not put you to sleep). A coronary angiography does carry some risks, especially in people who may have serious heart disease, but your doctor will only recommend this procedure if the benefits outweigh the risks
• Electrocardiogram (ECG) – an electrocardiogram records the electrical impulses of the heart and it can identify any problems with the heart rate and rhythm. It may also be able to show changes related to a blocked artery, which could be the reason for the angina. The ECG is a common test which is routinely done for people with any type of chest pain as it can provide a quick result
• Nuclear stress test – the nuclear stress test is similar to the exercise stress test, but in addition to the procedure in that test, a radioactive isotope is injected into a vein in the arm which travels to the heart and will display any blockages or narrowing in a coronary artery on the special scanner which displays the images for the cardiologist to diagnose. This test is usually performed more commonly instead of the coronary angiography, as it is less invasive, less expensive and quicker to help diagnose coronary artery disease
• Stress test – an exercise stress test involves being hooked up to some electrical monitoring leads to certain spots on the body, while walking on a treadmill. The speed and elevation of the treadmill is gradually increased until it is too difficult to continue. The stress test is done to measure the activity of the heart while exercising, from an easy pace to a more difficult one, to determine if there are any underlying problems with the heart (such as blockages in the arteries) which will be able to be diagnosed from the activity of the heart. The stress test is usually not performed on people who cannot walk

Conventional treatment of angina

Treatment of angina is based on lifestyle modifications and a number of different medications – those that provide immediate relief, medications that prevent long-term symptoms and medications that prevent worsening of coronary artery disease:

Lifestyle modifications

A number of lifestyle modifications are recommended for people with angina to help prevent worsening of symptoms and help with any underlying heart condition:

• Antibiotics – always use the antibiotics you have been prescribed around one hour before and also six hours after a dental procedure, to reduce risk of any bacterial infection of the heart
• Exercise – regular physical activity is recommended to help reduce the pressure on the heart and enable it to function better. People who have not exercised regularly should only do so under a doctor’s advise
• Stop smoking – people who smoke are recommended to stop because the chemicals inside cigarettes can damage the walls of arteries and make them more susceptible to blockages and narrowing
• Stress reduction – there are a number of stress reduction therapies available for people who experience prolonged stress, as it is not healthy for the heart and could be the reason for the angina. Stress reduction therapies include: meditation, tai chi and yoga
• Weight reduction – people who are very overweight and obese will be advised to lose weight, because their excess weight may be causing the angina and heart condition

Medication for immediate relief

There is one medication that is given to people with angina to be used to gain immediate relief from angina symptoms:

• Glyceryl Trinitrate (GTN) – this medication is effective in controlling the painful symptoms of angina very quickly but only lasts a short time. It works by dilating (opening up) the coronary arteries so that there is a better blood supply to the heart and so the pain symptoms are quickly reduced

Medications that prevent long-term symptoms

These medications are prescribed in people who have angina to try to prevent more serious complications of the underlying heart problems (usually due to the coronary arteries):

• ACE Inhibitors – these medication, also known as angiotensin converting enzyme inhibitors are a class of drug which are used to treat people with coronary heart disease. ACE inhibitors prevent the smaller arteries from constricting, which enables the heart’s workload (and pressure) to be reduced, which means they are also used in people with high blood pressure
• Beta-blockers – these medications are the first choice treatment to prevent further angina symptoms in people with chronic angina. This class of drugs makes the heart beat slower and with less force which helps to prevent future symptoms of angina. Beta blockers help to prolong life in people who have had a heart attack. Certain people may not be able to handle taking beta blockers, due to the side effects they cause – people with asthma, COPD, diabetes, heart failure or depression
• Calcium channel blockers – these medications open up (dilate) the coronary arteries to help improve blood supply to the heart. Some of these drugs make the heart beat slower and with less force to help prevent future symptoms of angina, as well as controlling spasms related to angina pain. Channel blocker medication may be used together with beta-blockers and nitrates for treating angina that is difficult to control
• Long acting nitrates – these medications open up (dilate) the coronary arteries to improve blood supply to the heart. They are similar in action to Glyceryl Trinitrate (GTN) but their effects last longer, although they are slower to have an effect
• Potassium channel activators – these medications help to open up (dilate) the coronary arteries to improve blood supply to the heart

Medications that prevent worsening of coronary artery disease

These medications are used in people who have existing coronary artery disease in order to prevent their condition from worsening. In this case, the angina is a symptom of the coronary artery disease (unstable angina):

• Anti-coagulants – this is a major medication to thin the blood and are especially used in the case of breaking up existing blood clots or to prevent future clots from happening
• Anti-platelets – these medications reduce the ‘stickiness’ of platelets (the type of proteins in blood that help it to clot) in people who are at risk of developing blood clots in one of their arteries. These medications prevent clots from forming and reduce the risk of a heart attack happening
• Aspirin – this over-the-counter medication is recommended to help to prevent blood clots from forming inside narrowed coronary arteries. Research shows aspirin can reduce the risk of a heart attack in people who already have coronary artery disease
• Statins – these medications lower blood cholesterol levels to lower the risk of blocked and narrowed arteries in people who have high cholesterol levels and need it to be lowered to reduce their angina symptoms

Surgery

Some people will need surgery to fix more serious underlying heart problems that cause angina pains:

• Angioplasty – this is a type of surgery to help open up a coronary artery which may be blocked. In this surgery, a wire with a sausage-shaped balloon is placed in one of the large arteries in the body that has a blockage and it is guided to the the narrowed section of a coronary artery. Once there, the balloon has air blown into it to open it up and remove the blockage so that the blood can flow more freely and angina symptoms can be greatly reduced
• Coronary artery bypass graft (CABG) – this is a type of surgery to bypass an artery blockage with healthy blood vessel segments (grafts) taken from other parts of the body so that the coronary arteries can function properly

Alternative / complementary treatment of angina

Anyone who has any type of chest pain must seek emergency medical advice

The alternative/complementary advice that is given here, may help to prevent angina (and heart disease) in the first place, but these strategies should not be used unless there is consent from your doctor. Supplements should never be combined with prescription (or over-the-counter) medications except with medical advice, as some combinations can produce serious complications.

Herbs

There are some herbs which have heart-protective benefits, but they need to be individually prescribed by a qualified herbalist to ensure the best benefit.

Vitamins

There are a number of vitamins which may be beneficial in maintaining good heart health (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Bioflavonoids – the antioxidant bioflavonoids, together with vitamin C, are necessary to help strengthen the walls of the capillaries, reduce the risk of plaque forming in the arteries, lowers the level of triglycerides in the blood and increases the level of HDL (“good”) cholesterol
• Folic acid – the B vitamin, folic acid has vasodilation properties, which helps to ensure the blood vessels and arteries are not narrowed to allow proper blood flow
• Vitamin A – the antioxidant vitamin A is vital for the reducing oxidative damage from free radicals and ensure the cells in the heart are healthy. Studies show that people who have low levels of vitamin A have a less favourable prognosis if they have any type of underlying heart disease that is causing the angina
• Vitamin B3 – studies show that niacin and niacinamide (two forms of vitamin B3), together may help reduce the risk of plaque forming in the coronary arteries
• Vitamin C – the antioxidant vitamin C together with the bioflavonoids, is necessary to help strengthen the walls of the capillaries, reduce the risk of plaque forming in the arteries, lowers the level of triglycerides in the blood and increases the level of HDL (“good”) cholesterol. Studies show that people who have low levels of vitamin C have a less favourable prognosis if they have any type of underlying heart disease that is causing the angina
• Vitamin E – the antioxidant vitamin E is essential for good heart health as it stabilised the heart, makes the blood less sticky and less likely to clot, dilates the blood vessels, which keeps them open and allows proper blood flow and it also reduces the risk of ischaemia, which is an inadequate supply of blood to the heart due to blockage in an artery. Studies also show that people who have low levels of vitamin E have a less favourable prognosis if they have any type of underlying heart disease that is causing the angina

Minerals

There are a number of minerals which may be beneficial in maintaining good heart health (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Magnesium – the mineral magnesium is really beneficial for the heart, as it helps to ensure the heart muscle is able to be relaxed (after contractions), functioning properly and the heart rate is normal. Adequate levels of magnesium are also necessary to reduce any calcium deposits in the arteries, which may cause blockages. One recent study suggested that magnesium deficiency may be the cause of the frequency of chest pain in variant angina. Another recent study suggested that intravenously given magnesium sulphate may significantly prevent spasms in the coronary arteries (variant angina)
• Selenium – the antioxidant mineral selenium is vital for the health of the heart and a deficiency is associated with a certain type of heart disease (Keshan’s disease). Selenium also help vitamin E function more effectively in the body, which helps to better promote heart health. Research shows that people with any type of heart condition, generally have deficient levels of selenium in their blood, while other studies show that selenium supplementation helps to improve symptoms of angina

Other nutrients

There are a number of other nutrients which may be beneficial in maintaining good heart health (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Arginine – studies show that the amino acid arginine is a vasodilator, which helps to keep the arteries and other blood vessels open, preventing narrowing and enabling proper blood flow. Studies show the effect of arginine on the arteries is greatly enhanced when vitamin C is also supplemented together
• Carnitine – studies show the amino-acid like nutrient, carnitine, is especially beneficial for the proper functioning of the heart and is well tolerated by people with stable angina. Carnitine helps with the production of energy at the cellular level and research shows it may help the heart produce more energy even with less available oxygen (due to the angina). Other studies show carnitine helps to transport the fatty acids into the mitochondria (for energy), increases levels of HDL (“good”) cholesterol and reduces blood triglycerides levels
• Coenzyme Q10 – studies show that coenzyme Q10 helps to increase oxygen supply in the cells of the heart (which enables it to function more effectively) and it may be a supplement supplement to prevent further heart attacks
• Essential fatty acids – the omega-3 essential fatty acids (DHA/EPA) are vital for good heart health, as they reduce any inflammation in the body (especially the heart), which is associated with heart disease, helps to thin the blood, which reduces likelihood of blood clots and blockages and are recommended for heart health in general
• Glutamine – the amino acid glutamine, is a potent antioxidant, which may help to reduce stickiness of the blood and blood clots
• Lipoic acid – the antioxidant nutrient lipoic acid, helps to ensure the optimal functioning of the other antioxidant vitamins, as it boost their function
• Taurine – the amino acid taurine is recommended as research shows it helps to stabilise irregular heartbeat (arrhythmia) which may be an underlying cause of the angina

Dietary modifications

There are a number of dietary modifications which may be beneficial in maintaining good heart health:

• Eat more fruit and vegetables – intake of fresh fruit and vegetables needs to be increased so that the diet includes about 2-3 portions of fruit and 5-7 portions of vegetables every day. The vitamins, minerals and especially the antioxidants in the fruit and vegetables can help the heart function more effectively and reduce the risk of blockages in the coronary arteries
• Eat more garlic and onions – both garlic and onions, but especially garlic have blood thinning effects, which may help to prevent stickiness and blood clots, as well as reduce the risk of artery blockages. Fresh garlic and onions, are best, but they can be cooked in meals. People who cannot tolerate garlic can try supplements, but always seek the advice of a medical doctor before trying supplements as they may not be recommended in conjunction to your other medication
• Eat more ginger – fresh ginger is highly recommended as it helps to reduce inflammation in the body. Fresh ginger can be finely grated into smoothies and fruit juice and it can also be cooked in meals
• Eat more oily fish – research suggests that people at risk of any type of heart disease should eat more oily fish (mackerel, salmon, sardines, trout, tuna). Heart foundations around the world recommends eating these types of fish around 2-3 times a week in order to provide adequate levels of the heart-healthy, anti-inflammatory omega-3 fatty acids from the fish
• Increase fibre intake – fibre is essential for ensuring good digestive health and good heart health, as adequate fibre intake reduces the amount of cholesterol in the blood and this may be helpful in reducing the risk of blockages by the cholesterol in the arteries
• Increase intake of potassium-rich foods – the mineral potassium is needed to counter the effects of sodium, especially in people with high blood pressure, whose heart may not be functioning properly and may be causing the angina. Foods high in potassium include: bananas, apricots, treacle, sultanas, raisins, wheat bran, figs, currants, unsalted nuts, baked potato and most fruits and vegetables
• Increase intake of magnesium-rich foods – the mineral magnesium is so beneficial for the heart, as it helps to ensure the heart muscle is relaxed, functioning properly and heart rate is normal. Foods high in magnesium include: beans, spinach, wholegrain bread and cereals, wholemeal flour, yeast, seafood, almonds, brazil nuts, peanuts, walnuts and treacle

Lifestyle modifications

There are a number of lifestyle modifications which may be beneficial in maintaining good heart health:

• Antibiotics – always use the antibiotics you have been prescribed around one hour before and also six hours after a dental procedure, to reduce risk of any bacterial infection of the heart
• Exercise – regular physical activity is recommended to help reduce the pressure on the heart and enable it to function better. People who have not exercised regularly should only do so under a doctor’s advise
• Stop smoking – people who smoke are recommended to stop because the chemicals inside cigarettes can damage the walls of arteries and make them more susceptible to blockages and narrowing
• Stress reduction – there are a number of stress reduction therapies available for people who experience prolonged stress, as it is not healthy for the heart and could be the reason for the angina. Stress reduction therapies include: meditation, tai chi and yoga
• Weight reduction – people who are very overweight and obese will be advised to lose weight, because their excess weight may be causing the angina and heart condition

Alternative treatments

There are no other alternative treatments recommended for angina.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before  you try it.

Living with angina

Management of angina requires a multi-level approach:

Dietary modifications

There are a number of dietary modifications that can be incorporated to reduce the impact of an unhealthy diet on the heart:

• Avoid eating large meals – people angina should eat about 5-6 smaller meals and avoid eating large meals which fill them up to much
• Fruit and vegetables – add more fruit and vegetables into your diet (your doctor will advise the same) to help your body get lots of antioxidants. Fruit should be fresh (and preferably organic) and vegetables should also be fresh (and preferably organic), with at least one raw salad, with lots of dark green leafy vegetables and other raw vegetables, plus some cooked vegetables. Aim to have 2-3 servings of fruit and about 5-7 servings of vegetables each day and don’t worry if some days you don’t meet this target, just try to do your best
• Garlic, ginger and onions – much research shows that garlic, ginger and onions are especially good for the heart, by reducing inflammation and ensuring the blood is less “sticky” and thick, which reduces the likelihood of any blood clots or blockages. Garlic, ginger and onions are also good for reducing levels of LDL (“bad”) cholesterol, reducing blood triglyceride levels and maintaining healthy blood flow and normal blood pressure. Since garlic thins the blood, talk to your doctor before using a lot of it if you are also taking any blood thinning medication (Warfarin, Heparin) as it could thin your blood too much
• More oily fish – people with any type of heart condition are advised to eat oily fish around 2-3 times a week (as recommended by the Australian Heart Foundation). Certain fish have very high levels of the anti-inflammatory omega-3 fatty acids which help the heart by enabling proper blood flow, reducing risk of blood clots, reducing levels of LDL (“bad”) cholesterol and reducing blood triglyceride levels

Lifestyle modifications

There are a number of lifestyle changes that should be maintained in order to help reduce risk of further damage to the heart and coronary arteries:

• Exercise – make sure you engage in regular exercise every day, for about 30 minutes to 60 minutes. Your doctor will advise how much exercise is suitable for you and also the type of exercise program
• Reduce stress – if you experience stress in your life, you need to try to reduce its impact by engaging in some type of relaxation therapy, such as meditation, tai chi or yoga, whatever works best for you
• Stay away from cigarette smoke – people who smoke are greatly encouraged to stop as the cigarettes damage the lining of the arteries and people who do not smoke need to stay away from other people’s smoke
• Take antibiotics before and after dental work – your doctor or cardiologist will prescribe antibiotics to take about an hour before and again six hours after any dental work, to prevent any infection in the oral cavity from affecting your heart

Medication

People with angina, especially if it is unstable or variant, need to monitor their symptoms and take medications as advised.

Medication is really important for underlying heart disease, as it can help to reduce some risk of having a heart attack, but diet and lifestyle need to be modified too, in order to significantly reduce the risk.

Caring for someone with angina

Partner

If you have a partner with angina, there are a number of helpful strategies you can be involved in to help support your partner:

• Cook smaller meals – your partner needs to avoid eating really large meals, so when you cook, try to cook smaller meals. Ultimately your partner should have about 5-6 smaller meals during the day and it would be encouraging (and more healthier for you too), to do the same
• Don’t smoke – if you smoke, only do so outside the house (and car) and never smoking near your partner as the second hand some for your cigarettes can damage their artery walls and exacerbate their angina
• Exercise program – encourage your partner to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your partner. Walking will most likely be advised, so go for regular walks with your partner, when your schedule permits
• Healthy diet – ensure to cook healthy and fresh food, with your partner and remove (or limit) processed foods, junk foods and saturated fats from your diet to help reduce their temptation to eat these types of foods

Friends

If you have a friend with angina, you can help support them through:

• Don’t smoke – if you smoke cigarettes, try to refrain from doing so around your friend, as your second hand cigarette smoke can damage their artery walls and exacerbate their angina

Parents

Parents of a child with angina (which while rare, does occur) can help their child with the following strategies:

• Antibiotics before and after dental work – either ensure you give your child the antibiotics or remind them to take them before (1 hour) and after (6 hours) any dental work, to prevent any possible infection in the tooth from affecting the heart
• Cook smaller meals – your child needs to avoid eating really large meals, so when you cook, try to cook smaller meals. Ultimately your child should have about 5-6 smaller meals during the day and it would be encouraging (and more healthier for you and the rest of the family too), to do the same
• Exercise program – encourage your child to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your child
• Healthy diet – ensure to cook healthy and fresh food, provide healthy lunches and snacks for your child, remove (or limit) processed foods and junk foods and saturated fats from the diet
• Fish twice a week – oily fish such as mackerel, salmon, sardines, trout or tuna should be part of your child’s diet at least two times a week. The fish can be steamed, grilled, baked or even fried, but only with good quality cold pressed, extra virgin olive oil
• Stop smoking near your child – if you smoke, only do so outside the house (and car) and never smoking near your child as the second hand some for your cigarettes can damage their artery walls and exacerbate their angina

References

Last reviewed and updated: 14 May 2024