Angina and Hydration: How To Prevent Angina Attacks

  • 1st Revision: Manisha Kuttetira
  • 2nd Revision: Wasi Karim
  • 3rd Revision: Keri Wilkie

What is Angina?

Angina (often called chest pain) is not a disease in itself but a symptom of an inadequate supply of blood and oxygen to the heart (coronary or ischemic heart disease). It is one of the major causes of suffering and death due to cardiovascular diseases. The prevalence of angina among UK adults is estimated to be 3-4% [1].

Typically, angina is identified by a constricting (tightening) chest discomfort (pain) that can radiate to the neck, stomach, shoulders, jaws, arms and even back; other symptoms of angina (which vary from person to person) include shortness of breath, sweating, and dizziness.[2] The pain can be relieved by using sublingual glyceryl trinitrate, a medicine that opens up the narrowed coronary vessels.[3]

Angina further splits into subtypes such as stable and unstable angina; the former is provoked by any form of exertion while the latter can occur at rest. There are various health-related and lifestyle factors that predispose an individual to angina.[4] They include: 

  • High blood pressure (hypertension)
  • High blood cholesterol
  • Diabetes
  • Family history of premature heart disease
  • Obesity 
  • Lack of exercise (sedentary lifestyle)
  • Smoking 

It is important to note that angina is a reflection of increased cardiac workload coupled with narrowing of the delicate blood vessels that supply the heart. Hence, achievable measures that reduce the two factors would go a long way in improving the symptoms: avoiding exercise when it causes discomfort, avoiding extremes of weather and tight clothing, minimising exposure to stress, and consuming sufficient amounts of fluids, especially water [5].

Water is Crucial to Overall Health 

Water is the key ingredient that sustains life: crucial for the normal functioning of the body in terms of digestion, respiration, voluntary/involuntary movement (lubricating joints and revitalising the muscle tissue), excretion of waste, metabolism, heat regulation, immunity, skin health, and even cognition and mood. 

Water forms an intricate part of the structure and function of cells, tissues, organs and systems (making up about 60% of the human body weight).[6] For the cardiovascular system, water ensures the free flow of blood and maintains a healthy structure and function of the heart and blood vessels. Water also helps in reducing the occurrence of postural hypotension (orthostatic hypotension).[7] 

The cardiovascular system transports water to the whole body, so when water levels change, it can impact cardiovascular health. Dehydration, which refers to a net loss of water, distorts the normal physiological balance leading to a wide range of diseases like stroke, diabetes, kidney stones, chronic fatigue and ischemic heart disease among others. It is important to note that a 20% loss of body water can lead to death [8,9].

How Can Dehydration Cause Angina? 

Pain is a response to abnormal cardiac workload. This abnormal workload often leads to the incomplete breakdown of glucose because of a relative lack of oxygen. 

Subsequently, there is an accumulation of toxic chemicals that irritate the pain nerve endings. For example, the heart normally pumps 2000 gallons of blood per day. However, when dehydration sets in, the heart pumps faster to get water around the body, causing the heart rate to increase. This can cause chest pain (angina symptoms). 

Dehydration also causes a thickening of the blood by making the heart work harder to pump blood around the body (increased blood pressure). Chronic dehydration increases the risk of arrhythmias, heart attacks, strokes, and other disorders associated with blood clotting and plaque build up in the heart. Atherosclerosis (plaque build up in the cardiovascular system) is a major cause of angina.[10]

How To Tell You are Dehydrated?

The sensation of thirst is often a foolproof sign that you are dehydrated. However, there are several indicators for optimal hydration which differ in sensitivity, cost, accuracy and reliability. They include skinfold thickness, changes in body weight, changes in urine and blood chemistry (body fluids composition and electrolyte levels) including physical appearance like the colour (a darker colour means less water), and vital signs (e.g. resting heart rate).[8] 

Overall, it is best to combine the above indicators to gauge the extent of dehydration. This is especially important because there is currently no perfect indicator for dehydration.[12] Each indicator has its own strengths and weaknesses so that when they are combined, their advantages can be maximised, while their disadvantages are minimised. Until a perfect indicator is discovered, research is still ongoing and current indicators are constantly being improved upon. 

Improving your Hydration Habits

How Much Water is Necessary for Optimal Health?

Water intake helps restore the negative fluid balance associated with dehydration.[13] n average of 8 glasses of water is sufficient to meet the body's hydration requirements. In reality, it varies among individuals and groups of people. For example, individuals assigned male at birth (AMAB) may need 13 glasses of water daily, while 9 cups are sufficient for individuals assigned female at birth (AFAB), and between 4 to 8 cups will do for children. Also, people that are physically active or living in warm dry climates may need more water compared to those who aren't. 

Although our hydration needs vary (according to age, climate, gender, disease status etc), the overarching goal is to achieve optimal water balance regarded as euhydration. Here net water gain is equivalent to net water loss. During dehydration, the focus shifts to minimising water loss and/or improving hydration (water gain).

Avoiding Alcohol and Caffeine

Alcohol and caffeine when taken in excess can promote water loss by increasing the volume and frequency of urination. This is often attributed to the diuretic effect they exert. If both beverages must be consumed, they must be taken in moderation. For example, consuming less than 180 mg of caffeine (equivalent to two cups of coffee) is optimal for keeping hydration at the desired level. Whereas with alcohol, your body can only metabolise one drink (2oz) before it starts to suffer from dehydration.

Other alternatives to water

There are alternative drinks to try if plain water is not your thing, preferably not alcohol or coffee for the reasons just highlighted above. Flavoured water and whole natural fruit juices are good options. Besides, you can eat your way to adequate hydration by consuming water-rich foods like cucumber, watermelon, and lettuce.    

Coupling drinking water with other habits is another way to ensure you make up the recommended daily requirements for water intake. For example, you could drink water as soon as you wake up, or before you read a book

Summary 

Angina is a major manifestation of coronary heart disease with life-threatening symptoms. These are responsible for high mortality and increased health burden. Several factors, both medical and lifestyle-related, can predispose an individual to the condition. To improve wellbeing it is important to address the modifiable risk factors (drinking sufficient water and reducing exposure to stress).

The importance of water for good health cannot be overemphasised. The cardiovascular system depends on euhydration to pump blood efficiently and transport blood through the vessels smoothly. On the other hand, dehydration can undermine cardiovascular health and trigger angina. Monitoring the extent of dehydration ensures that corrective measures are taken promptly to reduce harm.

In conclusion, managing our health boils down to our lifestyle. When it comes to ensuring adequate hydration, good habits go a long way. The benefits of drinking, or otherwise consuming (e.g. eating water dense food), water regularly extends beyond cardiovascular health (preventing angina attacks).   

Reference:

  1. Ford TJ, Berry C. Angina: contemporary diagnosis and management. Heart. 2020 Mar;106(5):387-398. doi: 10.1136/heartjnl-2018-314661. Epub 2020 Feb 12. PMID: 32054665; PMCID: PMC7035719
  2. Angina - Causes, symptoms & treatments n.d. British Heart Foundation. https://www.bhf.org.uk/informationsupport/conditions/angina  (accessed March 18, 2022).
  3. Glyceryl trinitrate (GTN): used to treat angina (chest pain) and anal fissures. NhsUk 2020. https://www.nhs.uk/medicines/glyceryl-trinitrate-gtn/  (accessed March 18, 2022).
  4. Angina n.d. British Heart Foundation. https://www.bhf.org.uk/informationsupport/publications/heart-conditions/angina  (accessed March 18, 2022).
  5. Monnard CR, Grasser EK. Water ingestion decreases cardiac workload time-dependent in healthy adults with no effect of gender. Sci Rep. 2017 Aug 11;7(1):7939. doi: 10.1038/s41598-017-08446-4. PMID: 28801682; PMCID: PMC5554208.
  6. Salas Salvadó J, Maraver Eizaguirre F, Rodríguez-Mañas L, Saenz de Pipaón M, Vitoria Miñana I, Moreno Aznar L. Importancia del consumo de agua en la salud y la prevención de la enfermedad: situación actual [The importance of water consumption in health and disease prevention: the current situation]. Nutr Hosp. 2020 Oct 21;37(5):1072-1086. Spanish. doi: 10.20960/nh.03160. PMID: 32960634.
  7. Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010 Aug;68(8):439-58. doi: 10.1111/j.1753-4887.2010.00304.x. PMID: 20646222; PMCID: PMC2908954.
  8. Jang S, Cheon C, Jang BH, Park S, Oh SM, Shin YC, Ko SG. Relationship Between Water Intake and Metabolic/Heart Diseases: Based on Korean National Health and Nutrition Examination Survey. Osong Public Health Res Perspect. 2016 Oct;7(5):289-295. doi: 10.1016/j.phrp.2016.08.007. Epub 2016 Aug 31. PMID: 27812486; PMCID: PMC5079212.
  9. Ma GS. [Hydration status and health]. Zhonghua Yu Fang Yi Xue Za Zhi. 2019 Apr 6;53(4):337-341. Chinese. doi: 10.3760/cma.j.issn.0253-9624.2019.04.001. PMID: 30982263
  10. Hermiz C, Sedhai YR. Angina. 2021 Dec 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32491604.
  11. Kavouras SA. Assessing hydration status. Curr Opin Clin Nutr Metab Care. 2002 Sep;5(5):519-24. doi: 10.1097/00075197-200209000-00010. PMID: 12172475.
  12. Barley OR, Chapman DW, Abbiss CR. Reviewing the current methods of assessing hydration in athletes. J Int Soc Sports Nutr. 2020 Oct 30;17(1):52. doi: 10.1186/s12970-020-00381-6. PMID: 33126891; PMCID: PMC7602338.
  13. Water. Harvard T.H.Chan. The Nutrition Source 2019. https://www.hsph.harvard.edu/nutritionsource/water/  (accessed March 18, 2022).

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Ezekwesiri Nwanosike

Master's degree - Drug Discovery and Business Strategy, The University of Huddersfield
I am a business-minded Pharmacist who specializes in leveraging clinical data to improve patient wellbeing. My passion is ensuring that quality, safe and effective health information/products are within the reach of everyone.

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