How does heavy meal precipitate angina?

How does a heavy meal precipitate angina?

Mechanisms:

1. After a heavy meal, blood is shunted to the gastrointestinal tract increasing sympathetic activity and splanchnic blood-flow. This results in increased myocardial oxygen demand.

2. Large meal causes increase in portal venous pressure thereby reducing venous return to the heart leading to decreased coronary perfusion.

3. Fatty meal causes elevation of serum triglycerides and free fatty acids which can cause vasoconstriction of the coronary arteries.

4. Hyperglycemia resulting from large meals promotes inflammation and oxidative stress that may precipitate acute coronary syndrome.

5. High insulin levels, associated with large carbohydrate consumption stimulate sympathetic nervous activity and may reduce myocardial blood flow.

Risk is particularly high for individuals with preexisting coronary artery disease, diabetes or other risk factors. To minimize the risk, individuals should avoid large, heavy meals, especially those high in fat and carbohydrates. Eating smaller, frequent meals and limiting portion sizes may help to prevent the symptoms of angina. Additionally maintaining a healthy weight, engaging in regular physical activity, and managing underlying medical conditions can help reduce the risk of angina precipitated by heavy meals.