Angina from Stress

What is Angina?

Have you ever felt a strange discomfort in your chest? This can be attributed to angina, which is a painful feeling that is normally felt in the chest when there is less blood flow to your heart.¹  Alongside the chest pain, it is possible to experience angina in your arm, stomach, jaw, or other places in the body.¹ Because angina is the symptom most likely to be related to heart disease and global death rates, it is extremely important to be informed of its signs and symptoms, and how it is linked with stress.²

Types of Angina (Brief)

The type of angina you develop is dependent on what caused the condition. Cleveland Clinic informs us of the four types there can be: ³

Stable angina

Also known as angina pectoris. This is the condition that is most frequently seen, and the pain is more expected because you can usually tell which factors might trigger it, such as stress or physical activities.^3,4 When you take a break from physical activity, the pain from stable angina should subside.³

Unstable angina 

This is an unpredictable condition, usually caused by a blood clot (when blood turns slightly solid) in your artery.^{3, 5} This type of angina usually signals a heart attack.³

Microvascular angina

Impacts the smallest blood vessels of the heart, and can also be caused by stress or normal activities.³

Variant angina

A rarer type which is more likely to happen at night and is usually experienced by the younger population.³ This angina occurs due to coronary artery spasms which can be caused by substance abuse.^3,6

Signs and Symptoms (Brief)

As mentioned, angina symptoms can be identified by the typical chest pain or angina pain elsewhere in the jaw, stomach, back, or neck.¹ Other symptoms could be indigestion and fatigue.² However, people assigned female at birth in particular have a greater chance of experiencing less frequent symptoms, such as dizziness, nausea, sweatiness, and breathlessness.¹

Causes and Risk Factors (Brief)

The causes of angina can be unrelated to the heart, or directly related to ischemic heart disease (ischemic referring to restricted blood flow in the body).^7,8 Causes not related to cardiac issues can be a result of anxiety or panic attacks, musculoskeletal issues, or lung disease.⁷

There are also two types of risk factors associated with developing angina modifiable and non-modifiable factors. Modifiable risk factors include high blood pressure, any current use of tobacco or past use, and diabetes. Non-modifiable risk factors can be older age, your ethnicity, or a familial history of coronary artery disease.⁷

Diagnosis

The American Heart Association says that angina can be diagnosed by a medical professional, who will aim to work out whether you have stable angina or unstable angina.⁹ Angina is normally diagnosed by a coronary angiography, which is an X-ray test, to see whether your arteries are blocked.¹⁰

After being examined physically, you will probably be asked about any family history of heart disease.⁹ The medical professional will also ask questions to discern whether your angina is life-threatening, such as what triggers the pain, and how long you have been feeling it for.⁹

What is Stress?

Stress is caused by a change in environment from inside or outside the body that elicits a biological response.¹¹ It is incredibly important to be educated on the effects of stress, since it is an everyday issue that people have to combat. Plus, other than angina, many other complications can occur as a result of stress.¹¹

Types of Stress

Acute stress arises instantaneously from specific situations, and is usually handled by your body’s stress hormones.¹² This type of stress can be felt during an important presentation. Acute stress can lead to sweating, headaches, and chest or stomach pain.¹³

Episodic acute stress is when acute stress is experienced frequently and can cause agitated and unfriendly behaviour to be displayed towards others. This type of stress can cause exhaustion.¹⁴

Chronic stress takes place over a long-term period, where people are continuously placed in situations where stress hormones are released.^12,14 Although its severity can vary, it is constantly present.¹³ This type of stress can be due to financial problems or a hectic job. Symptoms of chronic stress include a lack of energy, people isolating themselves, body aches, and sleep troubles.^13,14 Chronic stress has a connection to high blood pressure, diabetes, depression, and even heart disease, because the stress response system impacts other systems in the body.¹²

Physiological Impact of Stress on the Body

Studies have shown that a high production of stress hormones can result in declarative memory disorders (the memory that allows you to process facts).^11,15  Stress additionally takes a toll on a person’s immune system, which leaves their immunity compromised and they are consequently prone to getting ill more frequently. Stress negatively interferes with the gastrointestinal tract, by interfering with the process of absorption and secretion of stomach acid.¹¹ Studies are also proposing that stressful events can lead to a higher risk of cardiovascular disease.¹⁶

Effect of Stress on Angina Symptoms

Recent scientific work has introduced the idea that psychological factors are even more of a contributor to angina pain than coronary artery disease.¹⁷  Also, angina frequency is shown to be more connected to blood flow defects from acute mental stress rather than exercise stress testing (a test which measures the ability of the heart).^17,18 Excessive amounts of emotional stress can enhance the negative effects of angina, as the hormones produced following stress may narrow the arteries.¹⁹ Angina is linked to psychological stress, as a quarter of patients with a psychiatric issue experienced chest pain as a symptom.²⁰

British Heart Foundation describes broken heart syndrome, also known as takotsubo cardiomyopathy, as a condition that occurs after severe physical or emotional stress. This condition leads the main chamber of the heart that pumps blood to become larger and change its shape, which makes the heart muscle weaker so it can’t pump blood as well as before. The symptoms of broken heart syndrome can be similar to what can be experienced during a heart attack, such as chest pain that is instant and severe.²¹

Summary

Stress is a factor that is impossible to entirely remove from our lives, but taking steps to live a calmer lifestyle can help to reduce or prevent angina pain. By working to minimise the stress in our lives, a positive feedback cycle of angina itself causing more stress can be avoided. Because angina is associated with heart disease and heart attacks, it is always worth going to the doctor if you are concerned about the pain, since angina can be mistaken for other conditions.²²  In general, when trying to manage angina, exercise is beneficial as heart health can be monitored.³ However, exercise should be carried out in intervals; as mentioned, any angina symptoms tend to be alleviated when the exercise stops.³