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Changing Lifestyles, Changing Habits: When You have Angina

separator Angina is almost always a symptom of coronary heart disease. Its most common characteristic is pain in the chest. The pain occurs when there’s either a sharp decrease in blood supply to the heart, an increased demand for blood to the heart (which can occur during exercise, for example) or a combination of both factors.

According to the American Heart Association, more than 6 million people in the US currently have angina, and there are an estimated 350,000 new cases of angina diagnosed each year.

People who have angina describe it in various ways: pressure, heaviness, constriction, squeezing or tightness in the chest. The symptoms can range from mild to severe and can include

  • Shortness of breath
  • Nausea or vomiting
  • Sweating or cold or clammy skin
  • Light-headedness or extreme weakness

Sometimes angina is not just in the chest but can be felt in the neck, jaw, upper back, shoulders, arms, elbows or upper abdomen.

What’s the cause of angina?
The heart needs oxygen to function. Oxygen travels to the heart in the blood. When the passages through the arteries that carry blood to the heart muscles become narrow, blood does not travel to the heart as well as it should and angina pain may occur. This narrowing is called atherosclerosis. It’s generally caused by the buildup of cholesterol on the inside walls of the arteries. Recent studies indicate that inflammation in the lining of the arteries and the development of clots are factors that contribute to angina. Triggers for angina pain include

  • Increased physical activity (the most common trigger)
  • Extreme cold or heat
  • Heavy meals
  • Emotional stress
  • Consumption of alcohol
  • Smoking

In other words, angina pain is caused by activities that make your heart work hard. Having an episode of angina pain does not mean that a heart attack will definitely occur. If the heart muscle is deprived of oxygen long enough, the muscle will die, causing a heart attack. However, if the factors that caused the angina pain (activity, stress, etc.) are stopped, the angina pain can stop. In this situation, the heart muscle may not die, and a heart attack is prevented. Also, if angina is treated by medical professionals, a heart attack may be prevented.

Following your angina treatment plan
Your particular treatment plan for angina is based on the coronary artery disease risk factors you have. The most important thing you can do to prevent and treat coronary artery disease itself is to reduce your risk factors. The factors that you can control or manage to the best of your ability include:

  • High blood pressure (hypertension)
  • Smoking
  • High levels of blood cholesterol
  • Excess weight 
  • Diabetes
  • Inactive or sedentary lifestyle

The following are risk factors that cannot be changed:

  • Family history of atherosclerosis
  • Gender. Prior to menopause, women are less likely than men to have coronary artery disease. Within a few years after menopause, women are as likely and, in some situations, more likely than men, to be at risk for angina and heart attack.

Sticking with the treatment plan from your doctor is the best way to keep coronary artery disease from getting any worse. It has been shown in various studies that making necessary lifestyle changes can even reverse some of the damage caused by coronary artery disease.

Choices that decrease your risk of heart attack
Having angina gives you a strong wake-up call that you need to make some healthy choices that can decrease your risk of heart attack.

If you’ve had angina for any period of time, you’ve probably found some changes have been easier to make than others. The following are some of the challenges in improving your atherosclerosis risk factors.

Quitting smoking is extremely hard for most people. If you smoke now, and have been having a hard time quitting, talk to your doctor or other members of your healthcare team for advice about smoking cessation medications and programs.

Taking medication on a regular basis can also be difficult. If you have trouble remembering to take your medicine, try to set up a routine for taking it at the same time every day. Pair it with mealtimes, brushing your teeth, etc., so that these activities will help you remember. If you experience side effects from medication, be sure to talk with your doctor about them. Most important of all, don’t ever stop medication on your own. If for some reason you think you need to stop a medication, talk it over with your doctor first.

Changing the way you eat is a big part of your treatment plan. You may already know that eating high fiber, lower fat foods, including plenty of fruits and vegetables, is the best way to go. But are you clear about the best kinds of fat to eat? Do you know how to avoid saturated and trans fat, and how to include mostly monounsaturated fats in your diet? If your cholesterol, weight or blood sugars are above the recommended limits, talk with your doctor about ways to bring these risk factors under control.

The American Heart Association recommends a diet that gets no more than 30 percent of its calories from fat and only 10 percent from saturated fat. Talk with your doctor or other members of your healthcare team about these recommendations, and about how you can achieve and maintain this type of diet.

Reading food package labels is an excellent way to see which foods to eat and how much of them to eat. Labels are required to tell you what kind of fat, how many calories and how much fiber the product contains. Other nutritional information about salt, protein and carbohydrate content is also provided on the labels.

Exercise is important for people with angina, but it should be done only with the advice of your doctor and other members of your healthcare team. Since strenuous exercise can trigger an angina attack, you’ll want to start an exercise program gradually and build up as time goes on. Work closely with your doctor to develop a safe program you’ll stick with, one that fits your abilities and schedules.

Managing stress is important, but it’s often the last thing a lot of people want to focus on. Sitting quietly for 10 or 20 minutes per day (longer if you choose) and concentrating on your breath as it goes in and out is a simple way to relax your mind and body. Other ways include doing yoga or other stretching exercises, t’ai chi, qigong or biofeedback. Talk to your healthcare team members if you’d like to pursue some of these or any other activities that can help you reduce stress.

Remember, if your angina pain becomes more severe than usual, lasts longer than usual or doesn’t respond to medication as usual, emergency medical treatment IS necessary.

Patient education information from The National Institutes of Health, the American Heart Association and the National Heart, Lung and Blood Institute.
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