Angina and Nutrition

Short Explanatory Video

What is angina?

Angina also referred to as ‘Angina Pectoris’, is chest pain caused by a reduced flow of oxygenated blood to the heart due to the narrowing and/or partial blockage of the coronary arteries surrounding the heart.1 The main symptoms of angina include chest pain which may spread to other parts of the body such as the neck, back, jaw or arms and is usually triggered by emotional stress or physical exertion.2

There are two main types of angina; stable angina, which is more common and unstable angina which is known to be more severe. With stable angina, the attacks have a trigger which is usually emotional stress or physical exertion, and the attacks stop after a few minutes. In the case of unstable angina, the attacks are unpredictable and are not relieved by rest. 

Can food cause angina?

Food does not directly cause angina as angina is a symptom of Coronary Artery Disease. In medical terms, angina is a symptom of Myocardial Ischemia, where the build-up of plaque or cholesterol in the blood vessels occurs and can be damaging to the heart muscle. This limits the ability of the heart to pump blood effectively and results in the symptoms like chest pain which is classic to heart diseases.3

Food can contribute to the cause of angina

Cardiovascular disease develops because of blockage and narrowing of the heart arteries, which delay the delivery of oxygenated blood and nutrients to the heart and is characterized by chest pain (angina).  The main risk factors for cardiovascular disease are age, stress, genetics,  sedentary lifestyle, smoking and diet.4

It is recommended to follow a balanced diet, reduce the consumption of alcohol and increase physical activity to reduce the levels of unhealthy fats and cholesterol (plaque formation in the blood vessels). Consuming a diet high in saturated fats (for example, butter, cheese, cream), red meat), salt, sugar, and transfats can increase the risk of cardiovascular diseases. Opting for lean proteins, whole grains, and the consumption of polyunsaturated fats such as nuts, seeds, olive oil and fish have been associated with lower disease risk.5

In addition, limiting dietary salt intake has been shown to lower blood pressure and reduce the risk of angina. Processed foods such as smoked and cured meats, canned meals (spam, ravioli) and salted nuts can be consumed to a minimum for your heart health, especially by people who are already at high risk of the disease.6 A high intake of sugars can also be a concern for diabetics, especially those over the age of 55 years, when it comes to angina. Opting for sweeteners, reduced sugary food items, and foods containing natural sugars (e.g fruit) can be effective for controlling blood glucose levels

The treatment of angina depends on the type of angina. Stable angina can be managed with the help of medication and lifestyle changes. However, with unstable angina, surgical intervention may be necessary. Adhering to a balanced diet and following the recommended guidelines can contribute to the reduction of the risk of cardiovascular diseases, stroke and heart attacks and in turn, reduces the chance of angina. 

Angina vs heartburn

Heartburn is a common symptom of acid reflux, also referred to as Gastroesophageal reflux disease (GERD). Heartburn occurs when stomach acid enters the lower end of the oesophagus and causes burning chest pain that begins at the breast bone. The pain can travel up the oesophagus towards the throat, however, does not spread to the shoulders, neck or arms as it does in symptoms of angina. With heartburn, individuals often experience a bitter taste in the throat and the sensation of food coming back up.7

Angina symptoms differentiate from those of heartburn as the tight, and heavy chest pain usually occurs in the centre of the chest. The pain can also spread to different parts of the body and is usually accompanied by shortness of breath and dizziness.8

How to tell the difference between angina and heartburn?

There are key differences to look out for to distinguish between heartburn and angina. 

Symptoms of heartburn are :

  • Burning chest pain that begins at the breast bone
  • Pain spreads up the oesophagus towards the throat 
  • Pain does not radiate to another part of the body
  • Acidic taste in the throat 

Symptoms of Angina are: 

  • Tightness or dull pain in the centre of the chest 
  • Pain can spread to other parts of the body (neck, shoulders, jaw)
  • Irregular heartbeat 
  • Nausea and vomiting 

When to contact a doctor

If you experience any symptoms of angina, as mentioned below, contact your local GP and make an appointment immediately. If symptoms begin to escalate it is advised to call the ambulance and seek immediate help as these may be signs of a heart attack. 

  • Intense chest pain lasting longer than 5 minutes 
  • Pain begins to spread to the neck, shoulders etc. 
  • Sudden lightheadedness 
  • Vomiting 

Conclusion

Angina is characterized by heavy and dull chest pain, and although not caused by diet, it is a symptom of coronary artery disease where diet has significance and plays a role. A healthy diet, low in saturated fat, salt, and sugar can be implemented to improve stable angina and manage the prognosis of coronary artery disease. In more serious cases, lifestyle changes may not be sufficient, and medical intervention, as well as surgery, may be necessary.

References

  1. Angina pectoris(Stable angina) [Internet]. www.heart.org. [cited 2022 Sep 9]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/angina-pectoris-stable-angina
  2. Coronary heart disease [Internet]. nhs.uk. 2018 [cited 2022 Sep 9]. Available from: https://www.nhs.uk/conditions/coronary-heart-disease/
  3. Ahmed N. Myocardial ischemia. In: Pathophysiology of Ischemia Reperfusion Injury and Use of Fingolimod in Cardioprotection [Internet]. Elsevier; 2019 [cited 2022 Sep 9]. p. 41–56. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780128180235000029
  4. Cardiovascular diseases [Internet]. [cited 2022 Sep 9]. Available from: https://www.who.int/health-topics/cardiovascular-diseases
  5. Boston 677 Huntington Avenue, Ma 02115 +1495‑1000. Fats and cholesterol [Internet]. The Nutrition Source. 2012 [cited 2022 Sep 9]. Available from: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/
  6. Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III--Analysis of data from trials of salt reduction. BMJ [Internet]. 1991 Apr 6 [cited 2022 Sep 9];302(6780):819–24. Available from: https://www.bmj.com/content/302/6780/819
  7. Heartburn vs. heart attack [Internet]. Harvard Health. 2018 [cited 2022 Sep 9]. Available from: https://www.health.harvard.edu/heart-health/heartburn-vs-heart-attack
  8. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 aha/acc/ase/chest/saem/scct/scmr guideline for the evaluation and diagnosis of chest pain: a report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Circulation [Internet]. 2021 Nov 30 [cited 2022 Sep 9];144(22). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029

Darija Golubovic

Bachelor's degree, Nutrition Sciences, The Manchester Metropolitan University, England

I graduated from Manchester Metropolitan University with a First Class in Nutritional Science BSc.
I aim to continue promoting health, wellbeing and fitness and influencing healthy food choices and sustainability.
Registered Associate Nutritionist delivering the NHS Diabetes Prevention Programme.

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