Angina Mini Guide

For people with angina, breathlessness or ischaema ,with symptoms or without, it would be advisable for you to take some extra precautions when exercising, to ensure you are both safe and effective. 

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There are essentially two main classifications of angina - Stable and unstable.

Stable angina is when the symptoms are predictable and reproducible, it can be received by resting or using a GTN spray, and it is brought on by similar situations.

Unstable is when it is undiagnosed or the circumstances have changed in which it comes on. In the case it is not recommended for you to undertake any exercise until you have seen your doctor.

For those of you with stable angina When looking you’re exercising set your heart rate to 10-15 bpm below the ischeamic threshold. This threshold is determined by an ECG ETT which is commonly performed on a treadmill or bike testing looking for the point at which you start to experience symptoms of angina, which may include breathlessness, chest pain, dizziness or nausea. If you haven’t had an ECG tests then it would be a good idea to speak to your doctor to establish this threshold.

If this is not an option for you then you need to be aware at what level of intensity and heart rate - you can exercise to, before you experience symptoms and then record the heart rate. You can now use this as your upper limit and then set your heart rate monitoring device at 10-15 bpm lower than that figure. Example exercising at 115 bpm brings on the early signs of angina then set your limit at 100-105 bmp. But I would highly recommend that you seek medical assessment first.

Angina Triggers - what are the main things you need to pay attention to ? We have the four E’s. 

Exercise - Emotional Stress - Extreme cold - Eating

Exercise - the workload is increased for the heart due to an increase in heart rate and and increase in blood pressure. Isometric exercise should be avoided - anything like lawn mowing lifting furniture, or any prolonged static holds as blood pressure rises dramatically.

Emotional Stress - when we become overly emotional it has a direct effect on your heart by increasing heart rate and blood pressure. That’s just reminded me of another video we have on the channel for you which teaches you how to control your emotions which in turn regulate your heart.

Extreme cold creates an environment for increased demand of the heart and constriction of the peripheral arteries the ones in our extremities like finger and toes, that’s why they get cold in cold weather. This has the effect of increasing blood pressure. Constriction of the coronary arteries the arteries that feed the heart muscle, resulting in reduced blood flow to the heat muscle its self.

Eating - you may not expect this to have much of an effect but it can, as blood flow is prioritised for digestive purposes the hearts workload is increased. It increases by about 1 litre per minute about 30-60 mins after eating and can cause a bout, known as post prandial angina.

Unstable angina is categorised by the following indicators - so this is what to look out for -
1. Tightness burning or dull sensation in the chest,
2. Pain or heavy feeling in the left or right arms
3. Pain or discomfort in the throat abdomen, or back.
4. any changes in the established pattern of the current angina. if your exercising at lighter levels than normal but you are experiencing symptoms this is something to pay attention to,
5. new bouts of angina when doing tasks around the home that never bothered you before like going up the stairs previously was no problem but now you are noticing that it is becoming harder and you feel like a bout of angina may come on or does come on.

If this is the case then its time to revisit your doctor and update them on your new symptoms and present condition.

One tool you can use is an exercise heart rate monitor - there are many types on the market today and you can set your upper and lower limits on the device which will then alert you if you’re exceeding those limits. Very handy as it will keep an eye on you especially for those of you who like to work hard and get a sweat up !

One thing that is not recommended is high intensity upper body work - this should be avoided as there is less vascularity n the upper body and can create an increase in blood pressure.

Prophylactic prevention using GTN sprays (glycerol nitrate) prior to exercise may be appropriate, and can have significant benefits, but should be agreed upon with your doctor before use.

To summarise here are the main points: 

If you have unstable angina seek medical help to get it under control so it becomes stable angina.

Once stable you can then exercise, you can use the GTN spray prior to sessions to help.

Use a device to monitor heart rate and set the limits 10-15 bpm below your threshold.

Lastly remember that if you have stable angina and it becomes unpredictable by becoming more severe, more frequent or coming on at lower levels of workload or at rest then this is time to visit your doctor.

In Health & Happiness

Christian