Angina and Sweating

Is Excessive Sweating a Sign of Heart Disease?

Excessive sweating (scientifically known as hyperhidrosis) is a condition where the body produces more sweat than necessary. It can affect daily life, including interactions with others and self-esteem. Hyperhidrosis can be categorized into two different types, and understanding this may help identify its cause and treatment options.¹

Primary hyperhidrosis is sweating that is not caused by a medical condition, medication, or anything external such as exercise or heat.¹ It is difficult to identify exactly why a person may suffer from this type of hyperhidrosis, except that it is thought that the nerves responsible for triggering sweat glands are overactive. 

Primary hyperhidrosis generally includes sweating of specific ‘focal’ areas including the underarms, soles, palms, face, and scalp.² Sweating is also symmetrical in that it affects both the right and left sides of the body in the same way. Sweating can be limited to one area, although it is more common to experience sweating from multiple areas. Another key feature of primary hyperhidrosis is that the sweating episodes occur at least once a week but usually do not occur when sleeping.³

The other type of excessive sweating is called secondary hyperhidrosis and is caused by either a medical condition or as a side-effect from medication.¹ Sweating generally occurs on larger areas of the body as opposed to on smaller focal areas. Other differential symptoms are that sweating may occur while sleeping and usually occurs in adulthood, unlike primary hyperhidrosis which starts in childhood or adolescence.³

There are several reasons a person may suffer from excessive sweating. It may be related to a heart issue, but it could also be because of something completely different. 

What Can Cause Excessive Sweating (Hyperhidrosis)?

While the exact cause of primary hyperhidrosis is largely unknown, but possibly related to overstimulated nerves, secondary hyperhidrosis has many causes and is summarized in the table below: 

Causes of secondary hyperhidrosis

Alcohol

Alcohol can make you feel hot and sweaty for several reasons. Mainly, alcohol causes your blood vessels to dilate, increasing blood flow. This causes your skin to feel warm and sweaty.

Chronic pulmonary disease: acute respiratory failure

In respiratory failure, the lungs are having to work harder as they are not getting enough oxygen. Often breathing rate is increased and the skin can feel clammy with sweat, particularly at night.

Congestive heart failure

In patients with heart failure, the heart can’t function well enough to meet the needs of the body. The blood supply to the kidney is reduced and the kidney responds by retaining fluid. It is thought that sweating is triggered to try and get rid of the excess fluid.⁴   

Metabolic disorders (e.g. diabetes, low blood sugar)

A person with diabetes has problems controlling their blood sugar levels. When a person has low blood sugar (hypoglycaemia), the body’s ‘fight or flight’ hormone (adrenaline) is released, which causes sweating.⁵

Infections (e.g. tuberculosis)

Night sweats are a common symptom of tuberculosis, which is a bacterial infection affecting mainly the lungs. Infections generally cause sweating, because of a rise in body temperature. Your body produces sweat as a response to try and cool the body down.

Menopause

During menopause, a woman can experience changes in hormones, which can affect the body’s temperature control. Often women experience hot flushes which are accompanied by sweating.

Anxiety

Anxiety causes a release of hormones that trigger a stress response from the nervous system. This leads to a rise in body temperature and as a consequence, we sweat more.

Certain medications

Certain antidepressants, Insulin, Some diabetic medicines,  Viagra,  Steroids²

What is Subacute Endocarditis?

Subacute endocarditis is a bacterial infection affecting the endocardium, which is the tissue that lines the chambers of the heart. It most commonly affects people who have a pre-existing heart condition, and it usually develops slowly, taking weeks or months to fully manifest. It is difficult to pinpoint at first, as the symptoms associated with it, such as weight loss, fatigue, shortness of breath, and night sweats, are not very specific.⁶ 

What is Angina?

Angina, also known as angina pectoris, is a type of chest pain brought about by ischaemia, which is when there is reduced blood flow to the heart. As blood carries oxygen, this is now restricted to the heart and the heart has to work harder. 

Types of Angina

Stable, Unstable and Variant

Angina can be categorized into three main types: stable angina, unstable angina, and variant angina. 

Stable angina: Chest pain occurs during physical exertion (for example, walking or climbing the stairs). This usually dissipates when resting or through the use of medication. This is a very common form of angina.

Unstable angina: Chest pain occurs unpredictably and even when resting. It can be very dangerous as it is associated with acute coronary syndrome. This is where the blood supply to the heart is suddenly blocked and requires urgent medical attention. ِAn episode of unstable angina usually lasts longer than stable angina (can be 20 minutes or more).

Variant angina: This also known as Prinzmetal angina, is a rarer form of angina and is caused by spasms of the arteries, which causes a temporary reduction in blood flow. It can cause severe chest pain and can occur even when resting.⁷

Signs and Symptoms 

The most common symptom of angina is central chest pain, which is often described as tight or heavy. Other symptoms include pain radiating to the jaw or arms, shortness of breath, sweating, nausea, fatigue, and dizziness.⁸

Is Sweating a Symptom of Angina?

As angina is caused by reduced blood flow to the heart, the heart needs to work harder to receive an oxygen-rich blood supply. This takes more energy to do so and causes a rise in body temperature. As a consequence, sweating can occur in an attempt to cool the body down. This is because when sweat on the surface of the skin evaporates, it takes the heat with it - which is why your skin can feel very cool after sweating.

Is it the Same in Men and Women?

Angina symptoms can present differently between those assigned male at birth (AMAB) and those assigned female at birth (AFAB). Although both AMAB and AFAB experience chest pain, it is thought that AFAB can experience more stabbing pain as opposed to heavy or tight pain. AFAB may also experience additional symptoms, such as throat pain and stomach pain, and are more likely to experience shortness of breath and nausea.⁹

Causes and Risk Factors 

Coronary artery disease is the most common cause of angina. In this condition, the coronary arteries are narrowed and reduce blood flow to the heart. This narrowing is usually because of atherosclerosis. This is where there are fatty deposits that build up on the inside of the arteries. Over time they can harden and cause the arteries to become less elastic. 

Risk factors associated with angina include:¹⁰

• increasing age
• obesity
• smoking
• a poor diet
• hypertension (high blood pressure)
• lack of physical activity 

Treatment and Prevention 

Usually medication is the first step in treating patients suffering from stable and unstable angina. Nitrates are commonly used and usually come in the form of a spray or pill. When symptoms of angina appear, the nitrates are applied under the tongue so that they reach the bloodstream quickly and work to dilate the blood vessels. Other drugs given in angina include medications that help reduce the risk of a heart attack, such as clot-preventing drugs. 

If the heart condition causing angina is severe, a coronary artery bypass may be considered. In a bypass, veins are taken from another area of the body and attached to the blocked artery as a means of helping transport blood to the heart. 

Angioplasty is another procedure which involves inserting a balloon into the artery and inflating it once inside, to help widen the artery.¹¹

Measures to improve lifestyle may help prevent a worsening condition and can alleviate symptoms. These include smoking cessation, regular physical activity, moderate alcohol intake, and a good diet. 

Is it Angina or a Heart Attack?  When to Dial 999

Both angina and heart attacks are caused due to an issue with blood flow to the heart. However, angina is caused due to narrowed arteries and reduced blood flow, and a heart attack is the result of completely blocked arteries. For this reason, a heart attack is a serious and life-threatening medical emergency and requires urgent medical attention. Angina, on the other hand, does not always require medical attention, is not necessarily life-threatening, and can often be managed with drugs and rest. 

How to Spot the Difference

Angina pain can come and go, and there is often relief after taking a nitrate. This does not happen with a heart attack. Both conditions cause chest pain, sweating, nausea, and shortness of breath. If you experience these symptoms and are unsure, it is always best to err on the side of caution and seek medical attention. If you usually suffer from angina and the pain does not dissipate, it is best to urgently seek medical attention.

Summary

It is important to pay attention to your body and if you are suffering from something like excess sweating, by seeking medical attention, you may be able to determine its cause and receive proper treatment or management. Try and make a note of how often the sweating occurs, where on the body the sweating occurs and if you notice anything in particular that triggers it. This will help determine between primary and secondary hyperhidrosis.