Exercise Induced Angina

Do you get chest discomfort with activity?

This is known as exercise induced angina. Angina is generally caused from not getting enough blood through the arteries to supply the walls of the heart with enough blood flow to adequately pump. Angina can be caused by blockage, injury or spasms. It can be particularly irritating when it comes on with exercise. Here are some things to know about symptoms you might experience when exercising.

  • Warm up adequately to prevent angina with activity/exercise.Try to do 5-10 minutes of very light exercise with minimal resistance before pushing the intensity up and before increasing the resistance on your exercise equipment. This allows the arteries to dilate – or widen thus increasing the ability to bring more blood flow to the heart.
  • Never try to push through angina, as it is a warning that your heart isn’t getting enough oxygenated blood. When symptoms come on reduce your exercise intensity to see if it will resolve. Many patients can back down for several minutes and the symptoms resolve. If the symptoms do not resolve use your nitroglycerin medication as prescribed.
  • Keep documentation of the frequency of the symptoms. In particular you are looking to see if the symptoms are coming on at a specific workload, or if the frequency of the symptoms is increasing.
  • If you watch your heart rates, most physicians will advise you to keep your exercise heart rates 10 points below where you get the onset of symptoms. It is recommended you purchase a heart rate monitor – a watch and strap for the chest to be able to gauge your exercise intensity from your heart rate. I am old school and hold allegiance to the Polar Heart Rate Monitors, they will run you about $50.
  • Recognize you are not a perfectly tuned machine, some days are going to be rough and you will need to take it easy. Many factors contribute to increased angina symptoms including increased  physical and emotional stress on the body, fighting illness, blood pressure, sleep, temperature being very cold or high heat and humidity, timing of medications, timing type and amount of food in the system, blood sugar, hormones…you get the picture.
  • Some patients will always have angina symptoms due to the injury to the heart, the size of the vessels, or spasm. It is important to work with you physician to determine what amount of angina is acceptable. With small vessel disease (microvascular angina) many have to accept a certain amount. It is often graded on a 1-10 scale with 10 being the worst, and some patients were allowed by their physicians to exercise with symptoms of 1-3 on the 1-10 scale if they did not have abnormal blood pressure or ekg changes and were free of symptoms such as shortness of breath. Gradually as they improved their physical conditioning their angina threshold (the intensity of exercise which produces symptoms) increased to where they could tolerate more intense workloads without symptoms worsening.

When is it angina dangerous?

There is a difference in stable and unstable angina. Stable angina is predictable. It can be triggered by emotional stress, exercise, exposure to cold air, after eating large heavy meals. It is relieved with rest, and doesn’t usually have other symptoms such as shortness of breath, profuse sweating, nausea associated with it.

Unstable angina is angina that is different as it can occur at rest or wake you from sleep. It is a change in the stable angina symptoms meaning the symptoms are more frequent, more intense – may require more nitro than usual to relieve symptoms. It may be paired with other symptoms, profuse sweating, nausea, shortness of breath, weakness, a feeling of doom, lightheadedness. If you are experiencing symptoms of unstable angina you must contact your medical provider ASAP. Time is muscle and you don’t want to risk losing heart muscle.

12 thoughts on “Exercise Induced Angina

  1. Pingback: Exercise Induced Angina | Exercise for health | Scoop.it

  2. Pingback: Exercise Induced Angina | Heart diseases and Heart Conditions | Scoop.it

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  4. I am so glad to see you have included angina caused by coronary artery spasm or microvascular disease. Many doctors are still ignoring these etiologies of angina or failing to educate patients about there characteristics. Your explanation of stable angina in the case of spasm or MVD is right on. I am one of those people who will always have some angina with exercise or emotional stress. I use nitroglycerin prophylactically before exercise with my cardiologist’s blessing. This often heads off the chest pain before it starts.

    • Thanks Caryl for stopping by and reading my blog site. I am pleased you found the article helpful. Living with chronic angina is quite a challenge, and there is no one size fits all advice on heart problems as everyone has different issues. I like your site as well. Keep up the good blogging and best wishes on a healthy future.

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  7. I’m a 53 year old female. I had mild heart attack in July, two stents and balloon angioplasty and I felt amazing. About 3 months afterwards I started experiencing should, chest and back pain with any exertion. I had my 2nd angiogram and found that the previously ballooned only artery collapsed so I received another stent. The symptoms did not go away. Two weeks later I had my third angiogram to recheck the stents already in place and to check the artery behind my heart. There was extensive blockage in that artery and I received 4 more stents. I now have 7 and I am still getting the same pain upon any exertion. When sitting still I have no pain, If I ingest too much salt I have extreme pain, if I exert myself at all the pain start immediately. I also found that if I bend over (picking up thing off the floor or in my yard) that also triggers the pain. I’m just not sure what to do next, all I know is I do not want another angiogram unless I know for sure it will solve this pain.

    • I am sure it is very troubling to experience such symptoms when you initially felt good after the first stent. It isn’t unusual however. Atherosclerosis is progressive. There can be many issues such as a stent “jailing” or blocking another artery, a stent may not fit properly in the artery causing problems, even though they opened the artery there may be smaller arteries that are causing the discomfort that cannot be accessed via the angiogram – “small vessel disease”. You might explore EECP therapy which is a non invasive treatment – although time intensive which is great for persistent disabling angina. Check out Vasomedical.com for information – they aren’t the only provider there are many – but there is good information on their site about how it works. I was an EECP provider for years and saw many patients who couldn’t be helped through multiple stents and PTCA’s get relief from their symptoms this way. I would also suggest a second opinion might be helpful. Good luck and let me know if I can be of any further help.

  8. I’m glad I found this article, I am a 49 year old woman and have been experiencing exercise-induced angina for several years, and it has been getting slowly worse. I have good blood pressure and cholesterol. Treadmill tests turned up nothing, I didn’t even get angina because the treadmill started so slowly that I was able to warm up. I had an angiogram last week and while I was on the table, the cardiologist was saying how clean and blockage-free my arteries were when suddenly the artery in my right arm spasmed and he could not get the tube out. It was very painful, and he said he had to put in lots of medicine to get my artery to relax enough to let him pull out the catheter. It was the same pain that I feel when I suddenly exercise too hard. If I warm up, I’m always fine, but if I suddenly dart up one flight of stairs I feel like I’m going to die for two minutes, my arms and neck and chin ache so bad. I’m hoping that I can increase my threshold slowly through responsible exercise.

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