Angina While Running

Overview

It’s strange to think that chest pain may actually be quite common in athletes as chest pain is normally associated with a poor or sedentary lifestyle. However, usually in young athletes, chest pain isn’t a sign of heart problems. 

The term ‘angina’ typically describes chest pain associated with a reduced blood flow to the heart. This is usually a result of a partial blockage in one of the arteries.

What is angina & symptoms

The word ‘angina’ describes chest pain as a result of reduced blood flow to the heart muscle. Short for ‘angina pectoris,’ angina itself isn’t a life-threatening condition but is a really good warning sign that you’re liable to a heart attack or stroke. 

The main symptom of angina is chest pain. The chest pain tends to be described as feeling tight or heavy. This feeling may spread to other areas: your arms, back, neck or jaw. Less common symptoms include feeling sick or breathlessness. 

It is usually brought on by physical exertion or stress. Because of this, it usually stops after a few minutes of rest. 

Angina can be categorised depending on its predictability:

• Stable angina is much more common and is brought on after stress or exercise. As described above, it stops within a few minutes of rest after the trigger. This can eventually develop into unstable angina
• Unstable angina, although less common, is much more serious. These attacks are also more unpredictable as they aren’t normally associated with a trigger. They don’t subside as easily after resting¹

Another type of angina is microvascular angina. This involves the smallest blood vessels of the coronary arteries (the blood vessels that supply oxygenated blood to the heart vessels). This type of angina works differently to the typical angina described above. This is because it does not involve narrowing or blockage of blood vessels but instead is a result of endothelial dysfunction (endothelium is the type of tissue lining the blood vessels)²

Common causes of why you get chest pain whilst running

Trauma and Inflammation 

One potential cause is trauma and inflammation. Many high-performance athletes are subject to experience wear and tear of the muscles associated with their sport. In sports that involve high cardiovascular activity, this can also include the cardiovascular system. One particular condition that may be experienced is costochondritis - inflammation of the cartilage that connects the ribs to the breastbone (in the middle of your chest).³

This condition can cause sharp chest pain in the front or side of your chest that may feel more painful whilst moving, taking deep breaths or even lying down.⁴

Exercise-induced Asthma

Exercise-induced asthma is caused by strenuous exercise causing the narrowing of the airways. This can lead to feelings of chest tightness as well as shortness of breath, wheezing and coughing. These symptoms usually arise during or after exercise. It is better known as exercise-induced bronchoconstriction, which reflects the construction of the airways, but this isn’t a root cause of asthma. 

This is more likely to occur in people with asthma (approximately 90%), however can also occur in non-asthmatics. It is also common in high-level athletes.⁵

Pushing yourself too much

Sometimes the cause of chest pain whilst running is simply pushing yourself too much. This can be in many ways:

• You may be new to running, causing your body to continuously be at a new pace with new demands. As your body adjusts to your running pace, the pain should subside
• You may be dehydrated or your electrolyte balance is off. This can sometimes create a cramping sensation in your intercostal muscles (the muscles surrounding the rib cage)
• You may be suffering from heartburn. The food you may be consuming before your run can have an impact on your performance

Heart conditions

Sometimes the cause of the chest pain can relate to a heart condition, such as angina pectoris. This means that there is a partial blockage, affecting blood supply to the heart. When the body demands more oxygen for exercise, the heart beats faster to supply that oxygen but is unable to fulfil its own oxygen needs due to the partial blockage. 

It could also be related to other undiagnosed heart conditions, hence the importance of finding the route of the chest pain as soon as possible.

What to do when angina strikes while running

If angina strikes whilst running, you should slow down your pace and take a break. If the chest pain is new and undiagnosed, contact your doctor in order to explore the cause and ensure it’s nothing serious before resuming your running regime.

If it’s of a known cause, take the cause of action discussed with your doctor in order to get back to running safely:

• If you suffer from asthma, use your inhalers as prescribed in order to aid
• If you have been diagnosed with angina, use your GTN sprays or tablets as prescribed by your GP
• If it’s costochondritis, it usually clears up by itself with a rest period, sometimes with the help of anti-inflammatories such as ibuprofen

Tips to avoid angina before running 

If you have been diagnosed with angina and are worried about running or exercise, following the below tips can lower the risk of an episode:

• Build up your activity level - don’t push your body too much too quickly
• Ensure you allow yourself plenty of time to warm your body up before your run; this allows the blood vessels to widen and potentially decreases the chances of angina
• If you have any angina symptoms before you start running, do not try to exercise until the symptoms ease or rest before continuing
• If your doctor has prescribed you GTN spray (glyceryl trinitrate) to help with angina during exercise, keep it on hand with you, and use it as prescribed
• Speak to your GP if you have any concerns regarding exercise with angina also

It’s important to not stop running or exercising completely, as having an inactive lifestyle can make symptoms worse. Exercising also reduces the risk of having a heart attack or stroke.¹

If you're new to running, it's important to build up small achievable goals for yourself. A good way to do this is using Couch to 5K in order to introduce yourself to running and build a good routine with it.

If heartburn is the cause of your chest pain whilst running, it's important to not have a full meal before your run or foods which may exacerbate the heart burn, for example spicy foods, and caffeine. Instead, consider having a small pre-run snack in order to properly fuel your run.

When To see a doctor

It is extremely important to seek medical attention immediately (call 999) for sudden onset of chest pain that:

• Feels tight or heavy
• Spread from the chest to the arms, back, neck or jaw
• Lasts longer than 15 minutes
• Involves feelings of shortness of breath, sweating or feeling sick

This is to ensure that you aren’t having a heart attack or, in order to treat the heart attack as soon as possible.

If you’ve never been diagnosed with chest pain or angina before and experience any chest pain that does not match the above description you should contact your GP or follow NHS 111 guidelines to seek further help and guidance as soon as possible.

Aisha Yasin

Biomedical Science - Biomedical Sciences, General, Lancaster University, England

"I am a recent biomedical science graduate, with ambitions to go on to do post-graduate medicine. During my biomedical science degree I have done a variety of modules including anatomy, physiology, clinical biochemistry and many more... Currently working as a healthcare assistant for P&O Cruises"

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