Angina: Are you listening to your heart?
In South Africa, cardiovascular disease (CVD/heart disease), which includes coronary artery disease (CAD), is the leading cause of death after HIV/Aids and the most frequent cause of death worldwide today (1). More South Africans die of CVD than of all the cancers combined. A common symptom of CAD is angina, yet many people don’t even know what that is. As a result, it is under-recognized and undertreated.
What is angina?
Angina occurs when the heart muscle needs more blood and oxygen than it is getting, for example, during times of physical activity or emotional stress. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you’re sitting. But, with physical exertion – like walking up a hill or climbing stairs – the heart works harder and needs more oxygen.
Prof David Jankelow, an adult cardiologist and president of the South African Heart Association, strongly recommends that the symptoms and signs of angina are not ignored: “Angina acts as an alarm bell that our hearts may not be receiving the oxygen they need.”
If you experience chest pain or discomfort during physical exertion, this may be your heart’s way of telling you that there is a problem. Angina is often described as a squeezing, heaviness or pressure-like sensation. It is relieved by rest or anti-anginal drugs.
What causes angina?
The main cause of angina is atherosclerosis – the arteries become clogged with fatty substances called plaques, or atheroma. This causes them to harden and narrow, restricting the blood flow and oxygen supply to the heart. It normally occurs in people over 50. Risk factors include diabetes and dyslipidemia (high cholesterol levels).
Prof Liesl Zuhlke, Immediate Past President of the South African Heart Association, says: “Angina has a negative impact on the quality of life and leads to a 3-fold higher risk of disability, a 1.5-fold higher risk of job loss, and a higher risk of anxiety and depression.”
What are the symptoms?
The signs and symptoms of angina can include any of the following:
- Chest discomfort that occurs with physical exertion or emotion (often described as a pressing or heavy feeling associated with shortness of breath and sometimes nausea and sweating)
- Undue tiredness
- Pain at a site other than the chest
- A sensation of indigestion or discomfort in the abdomen
Stable versus unstable angina
If you stop what you are doing, and the pain or discomfort usually stops too, this is known as stable angina.
However, if you experience symptoms of angina that occur without exertion, such as when you are resting, watching television or reading, or the symptoms occur after minimal exercise and do not stop after resting or your usual medication, this is known as unstable angina. It is important to seek help immediately in this case, as this could be a sign of a heart attack.
What to look out for
Have you experienced angina symptoms during the last week or month? Be ready to answer the following questions when visiting your doctor:
- Is it pain? Discomfort? Tightness? Pressure? Sharp? Stabbing? Fatigue? Breathlessness?
- Where is the pain located? Does the pain spread to your neck and arms? Is it in a specific area or more generalized?
- How and when did the pain start? Did something specific seem to trigger the pain? Does it start gradually and build up or start suddenly?
- How long does it last?
- What makes symptoms worse? Activity? Breathing? Body movement?
- What makes symptoms disappear? Rest? Deep breath? Sitting up?
- Are you dealing with other symptoms of pain, such as nausea or dizziness?
- Do you have trouble swallowing?
- Do you often have heartburn? (Heartburn can mimic the feeling of angina)
There are two aims in treating angina: to allow you to lead a normal, symptom-free, healthy life, and to prevent the occurrence of an event such as a heart attack. Making lifestyle changes and using antianginal drugs that can help treat heart disease caused by a restriction in the blood supply is the best long-term strategy.
If you have angina, you must take your medicines as prescribed by your doctor. Furthermore, you should know what medicines you are taking, the purpose of each of them, how and when to take them, and the possible side effects. You should never stop taking your medicines without your doctor’s approval.
“It’s important to speak to your doctor or cardiologist if you have any of these symptoms,” says Prof Jankelow. “Recognising the signs early lets you enjoy the benefits of treatment.”
The importance of lifestyle changes
Once your angina is controlled, it is important to take steps to reduce your risk of having further problems in the future. These include:
- Trying to lose weight if you’re overweight.
- Eating a healthy diet.
- Being active and exercising regularly.
- Quitting smoking if you smoke.
Being overweight or obese is a risk factor for ischemic heart disease and heart disease in general. You can reduce your risk for heart disease by losing weight and keeping it off. Even small and consistent changes can make a big difference.
To lose weight, you should:
- Know your calorie needs according to your age, sex, and level of physical activity.
- Track your calories by keeping a food diary, even for a few days; you will learn a lot about your eating habits.
- Practice regular physical activity; having a healthy and active lifestyle can help you achieve or maintain a healthy weight.
Making lifestyle changes and using medication to control risk factors and treat angina is the best long-term strategy.
Living with angina
Angina does not have to limit you. With the right treatment, you can live symptom-free with improved quality of life. “Ignoring angina is not a solution,” says Durban cardiologist Dr. Sajidah Khan. “Speak to your doctor about how angina can be managed.”
Listen to your heart, and if you suspect that you or a loved one has any symptoms of angina, speak to your doctor for more information and treatment options.
Angina Awareness Week
The South African Heart Association is promoting its first Angina Awareness Week in April 2019. It is part of a new worldwide initiative spearheaded by the ESC Working Group on Cardiovascular Pharmacotherapy and is aimed at increasing awareness about angina and its risk factors among patients and healthcare providers. This initiative is supported by an unrestricted grant from Servier.