Heart Mark

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My mother keeps having angina attacks. Is that like a heart attack? Please can you tell me the difference between angina, a heart attack and cardiac arrest?

What is angina?

Angina (or angina pectoris) is a common type of chest pain or discomfort that usually lasts only a few minutes. Some people describe it as a dull persistent ache. For some people the pain is severe, for others it is not much more than mild discomfort.

What causes angina?

It occurs when your heart muscle doesn't get the blood supply and oxygen that it needs. The difference between angina and a heart attack is that with angina, the chest pain goes away with rest or medication and does not cause permanent damage to the heart muscle. Often angina is brought on by physical activity or emotional stress when your heart rate and blood pressure increase and your heart muscle needs more oxygen.

What do you do if you think you have angina?

Your doctor will be able to diagnose whether you have angina from the symptoms that you describe. He or she may want to carry out a health check or send you for some tests.

You may be prescribed medication to help control your symptoms, while some people may require treatments such as the placement of a stent(s) or heart bypass surgery. Living a healthy lifestyle is a vital part of your treatment as well.

What is a heart attack?

A heart attack is similar to angina, but is more severe, lasts longer and causes permanent damage to the heart muscle. It happens when there is a sudden blockage to an artery that supplies blood to your heart.

What are the warning signs of a heart attack?
Symptoms vary from person to person, but watch out for:

  • Chest discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, indigestion or pain
  • Discomfort or pain in other areas of the upper body which can be experienced in one or both arms, the back, neck, jaw or stomach
  • Shortness of breath
  • Other signs such as breaking out into a cold sweat, nausea or light-headedness
  • What do you do if you think you or someone close by is having a heart attack?
  • A heart attack is life threatening! You are more likely to survive a heart attack if you phone emergency medical services straight away. Call for an ambulance immediately!

Cardiac arrest

A cardiac arrest is totally different from a heart attack. Heart attacks are cause by a blockage that stops the blood flow to the heart. Cardiac arrest happens when the heart’s electrical system does not function properly and your heart stops pumping blood around the body. As a result you will be unconscious and won’t be breathing normally.

  • It is usually caused by abnormal or irregular heart rhythms (called arrhythmias). Death can occur within minutes after the heart stops. Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is given and a defibrillator device is used to shock the heart and restore a normal heart rhythm within a few minutes.What are the warning signs of a cardiac arrest?
  • Sudden loss of responsiveness (the person will be unconscious)
  • No normal breathing
  • What do you do if you witness a cardiac arrest?
  • A cardiac arrest is an extreme emergency! Immediate cardiopulmonary resuscitation (CPR) and defibrillation is needed to have any chance of survival. You can increase the person’s chances of survival by calling for an ambulance and giving immediate CPR.
Are avocados good for heart health – if so, how much?

Although avocados have a high fat content, the good news for avo lovers is that the fat is mainly monounsaturated fat – a healthy fat which can help lower cholesterol levels. Avocadoes also contain plant sterols which block the absorption of bad cholesterol. Moreover, avocados are a good source of fibre, vitamins (B6, C, E, folate and potassium) which are important nutrients to help your heart stay healthy.

If you are watching your weight remember that if you eat more calories than you need, you will gain weight, so try to stick to moderate portions. A quarter of a small avocado (30g) is equivalent to a fat serving (e.g. a teaspoon of oil or margarine). So, for a heart healthy snack, enjoy a thin spread of mashed avocado on whole wheat bread or crackers instead of your usual scraping margarine.

Can you assist with info on obesity?

Statistics show that 1 in 3 men and 2 in 3 women in South Africa are overweight or obese! These are shocking statistics and are clearly a major public health concern in South Africa. Being overweight or obese puts you at higher risk for health problems, including: heart disease, stroke, high blood pressure, diabetes, certain cancers, gallstones and degenerative joint disease.

Obesity is defined as too much body weight. It is caused mainly by taking in more calories (energy) in the diet than what is used up in exercise and daily activities. There are many different underlying reasons contributing to overweight and obesity, e.g. urbanization and the move towards an unhealthy, westernized diet.

How do you know if you are overweight or obese?

Weight status can be assessed using various measures including body mass index (BMI) or waist circumference.

Body Mass Index (BMI)

To measure your BMI, you need to take your weight (in kg) and divide it by your height (in m2) i.e. BMI = weight/(height x height).

The following table will help you to determine how healthy your BMI is:

BMI (kg/m2)


Disease risk

Less than 18.5 Underweight -
18.5-24.9 Normal (healthy) -
25-29.9 Overweight Increased risk
30 or more Obese High risk

Some people (e.g. body-builders or well-trained people with dense muscle mass) may have a high BMI score but they may have very little body fat. For these people, a waist circumference measure, a skinfold thickness or other more direct methods of measuring body fat may be more useful measures.

Waist circumference 

Waist circumference is the measurement around your natural waist (just above the belly button). It can also be used to determine disease risk. A waist circumference of more than 88cm for women and 102cm for men indicates an increased risk.

Reducing your risk:

Obesity is now recognised as a major, independent risk factor for heart disease. If you're overweight or obese, you can reduce your risk by successfully losing weight and keeping it off. Even losing a few kilograms can provide you with health benefits, so consider working towards a healthier weight. Set a reasonable and realistic goal for weight loss (see question 5 for tips about weight loss). Remember to increase your day to day physical activity levels and do regular exercise as well! 

Can you recommend a diet for a patient who has had a heart op/by-pass surgery?

After a heart op or by-pass surgery, it is important to change your diet to prevent your arteries becoming blocked again over time.

  • Aim to lower your blood cholesterol levels by reducing your intake of foods high in saturated fat, trans-fats and cholesterol such foods as butter, cream, cheese, creamy sauces, pastries, fatty sausages, pies, creamy cakes, salami and other refined fatty foods.
  • Substitute the bad fats with a little of the good (unsaturated) fats such as olive, canola, nut, avocado or grapeseed oils ensuring that intake is moderate so as to avoid gaining extra weight.
  • Increase your intake vegetables and fruit.
  • Have plenty of fibre from such foods as oats, high fibre cereals, beans, peas, lentils, whole grain bread.
  • Drink lots of water every day.
  • Include some fatty fish (e.g. sardines, pilchards, salmon, mackerel) as they are rich in healthy omega-3 fats.
  • If you do drink alcohol, stick to moderate amounts (2 units/day for men and 1 unit/day for women).
I need to lose weight – what is a good weight loss meal plan?

See our general tips below as well as our standardised weight loss meal plan (click here) to help you with your weight loss.

If you have any specific health conditions (e.g. diabetes, allergies) it is best to consult a registered dietitian for a more personalised weight loss plan that takes your lifestyle and medical history into account.

  • Eat less – reduce your portion sizes and use a smaller plate. Try not to overload your plate with food. Rather dish up a smaller plate first time around and then if you are still hungry after the meal, have some more vegetables or salads.
  • Avoid eating when you are not hungry and eating out of boredom or frustration.
  • Stick to three balanced meals a day and have healthy snacks such as fruit or veggie sticks in between if you’re really hungry.
  • Drink lots of water every day. You may find that filling up on a glass of water with meals helps to prevent you from overeating.
  • Make sure that your starchy foods are high fibre or are wholegrain, as these will keep you feeling fuller for longer. Some examples include whole wheat bread, oats, brown rice, etc.
  • Choose lower fat foods (preferably fat free) to help reduce your total energy intake. Cook using low fat methods (e.g. baking, boiling, steaming or grilling) and avoid adding unnecessary oils and fats to your food.
  • It is very important to increase your level of physical activity. This will have many beneficial effects on your body and help you strive towards a healthier weight.
  • Eat slowly and enjoy your food.
  • Stop yourself from picking at food while you are cooking or clearing up. Only eat as part of a planned meal.
  • Avoid unhealthy take away foods or eating out too often (see our tips for better choices when eating out).
  • Cut down on your alcohol intake and sweets, chocolates, cakes, biscuits, chips, pastries and sugary drinks.These 'treats' often become habits and can lead to further weight gain.
  • Choose a salad as a fresh and healthy start to your meal.
  • Avoid fad diets. Generally these ‘magic’ cures are expensive with only short-term results, and weight is picked up again in the long term, often more than the original weight. With quick weight loss, it is usually not fat that is lost, but fluid and muscle mass. Be on the look out for the following:
  • Promises of large and rapid weight loss within a short period
  • No exercise required
  • Special garments or passive exercise machines involved
  • Magical ingredients with special abilities to speed up metabolism
  • Claims that you can eat as much as you like and still lose weight
  • Combinations of specific foods are advocated
  • The use of only one or two types of food
  • An exotic range of expensive and unusual foods
  • Special powders, pills and meal replacements
  • Food replacements and vitamin/mineral supplements
Can you give me the Heart Foundation/British Heart Association Diet?

The Heart Foundation diet is a crash diet whose origin is not certain. Although the diet carries the name of the Heart Foundation, it is not associated with the foundation whatsoever. The diet has been in circulation for a long time and claims that people who use it can lose more than 10 pounds (approximately 4.5 kg) within three days. The diet is associated with a sudden and severe reduction in kilojoules that results primarily in fluid loss. It is low in food variety and nutritional value, and includes some unhealthy choices such as high fat savoury biscuits, cheddar cheese, ice-cream and processed sausages.

The Heart and Stroke Foundation SA (HSFSA) does not recommend nor approve of this fad diet. We advise following a healthy balanced diet (click here for the HSFSA weight loss meal plan) as well as plenty of regular exercise to help with weight loss.

Can you provide me with a meal plan and info about diabetes?

Diabetes is a condition where high blood sugar (glucose) levels occur as a result of the body’s decreased ability to produce or respond to insulin, which regulates blood sugar. Importantly, while diabetes may not be curable, it is a condition which can be managed and controlled. Proper diabetes management is important to prevent complications, which can occur as a result of poor control of blood sugar levels. Very high blood sugar levels could result in diabetic emergencies e.g. coma. If blood sugar is uncontrolled over time, it can also result in other serious complications e.g. loss of vision, kidney failure and nerve damage. Also, a major concern is that diabetics are at high risk for cardiovascular disease – in fact, cardiovascular disease is the main cause of death in diabetics. Good blood sugar control is very important to prevent complications, including cardiovascular disease.

Diabetics need to follow a healthy lifestyle to control blood sugar. Diet plays a major role, and the following tips should help you:

  • Attain and maintain a healthy body weight.
  • Eat regularly and do not skip any meals or snacks.
  • Make sure that your diet is rich in fibre e.g. whole wheat bread, high fibre cereals, dry beans, vegetables and fruit.
  • Avoid refined carbohydrates such as products made from white cake flour, sweets and foods and drinks containing sugar.
  • Include at least five portions of vegetables and fruit in your diet every day.
  • Limit fat intake, especially saturated fats (which are mostly animal fats) e.g. chicken skin/fatty mince, cheese, butter and fatty snacks such as chips and chocolates.
  • Remove all visible fat from meat (and take the skin off chicken) before cooking.
  • Use healthier cooking methods such as steaming, baking, microwaving, boiling, grilling or braaiing over the fire instead of deep frying in oil or adding unhealthy fats.
  • Sugar and alcohol should only be used by well controlled diabetics and then only in limited quantities.
  • Salt intake needs to be limited, as excessive salt intake contributes to high blood pressure. High salt foods include table salt, stock cubes/powder, packet soups, processed foods (e.g. Russians, polonies, viennas) and salty snacks e.g. crisps, biltong.
  • Drink at least 6-8 glasses of water per day.
  • Do regular physical exercise of at least 30 minutes five times per week. Exercise can accelerate weight loss and improve glucose tolerance by heightening sensitivity to insulin. A health professional should, however, be consulted before starting an exercise programme.
  • It is recommended that you consult with a dietitian individually for a personalised meal plan, especially if you are on insulin.
What exactly is cholesterol and how do I lower my cholesterol levels?

Cholesterol is a fatty substance which is needed for certain essential functions in the body, such as the proper functioning of hormones which control many body processes. However, excessive cholesterol levels in the blood can be dangerous, as it can lead to cardiovascular disease, including heart attacks and stroke, in the long run.

There are different factors which contribute to increased cholesterol levels. Familial hypercholesterolaemia (FH), an inherited condition, which leads to extremely high blood cholesterol levels, contributes to some people’s high cholesterol levels. There are some South African demographic groups who are more at risk for FH.

Other major causes of high cholesterol levels are poor lifestyle habits such as diets high in saturated and trans fats.

Healthy lifestyle changes are important to lower cholesterol levels and reduce your risk of CVD. Steps you can take include:

  • Lower saturated and trans fat intake by decreasing your intake of foods including: cream, butter, coffee/tea whiteners, hard margarines, ghee, fat on red meat, chicken skin, fried foods, commercially baked products and processed foods.
  • Choose heart healthier fats such as vegetable oils, soft tub margarine, nuts, seeds and avocado.
  • Eat fatty fish twice a week e.g. sardines, pilchards, mackerel or salmon.
  • Cut down on foods high in cholesterol e.g. organ meats (liver, kidney, brains) and some seafood (caviar, shrimps, prawns and calamari).
  • Choose foods high in fibre e.g. oats, whole wheat breads, legumes (beans, peas, lentils).
  • Use healthier cooking methods, such as boiling, baking, grilling, steaming or poaching, rather than frying foods in oil or butter.
  • Be active. Do at least 30 minutes of moderate physical activity five days a week. Remember to consult with your doctor before starting an exercise programme.
  • Stop smoking and avoid exposure to second-hand smoke.
How can you prevent heart disease/stroke? What is a heart healthy diet?

Prevention of cardiovascular disease (CVD, which includes heart disease and stroke) should be a priority in our lives. Up to 80% of CVD is preventable by making healthy lifestyle choices – which shows that by making the changes, you can significantly decrease your CVD risk! A healthy lifestyle means: good nutrition, exercise and avoiding smoking.

Some tips to eat healthily:

  • Eat plenty of vegetables and fruits (at least 5 a day).
  • Include whole grain and high fibre foods, for example whole wheat bread, legumes and oats.
  • Try to include fatty fish (e.g. sardines, pilchards, salmon, mackerel) at least twice a week.
  • Keep meat intake lean and limit red meat to 2-3 times per week.
  • Stick to fat-free or low-fat dairy products.
  • Eat fats sparingly, limiting ‘bad’ fats (e.g. fatty meats, fried foods and high fat snack foods) and substituting them for ‘good’ fats instead (e.g. vegetable oils, soft tub margarine, nuts, seeds, avocado) in your diet.
  • Limit your daily intake of foods high in cholesterol, such as organ meats, shrimps and prawns.
  • Limit your intake of refined and sugary foods or drinks, e.g. fizzy drinks and sweets.
  • Use salt sparingly. This means using less in your cooking and not adding extra salt to your food at the table. Also remember that there is plenty of hidden salt found in processed foods (e.g. polonies, viennas, crisps, etc), so try to avoid these foods and choose lower salt options.
  • If you drink alcohol, do so in moderation. Limit it to 1 drink/day for women and 2 drinks/day for men.
  • When shopping, remember to choose foods with the Heart Mark as these are healthier options.


The HSFSA recommends that you do at least 30 minutes of moderate physical activity five days a week to decrease your risk of CVD. If you don’t do any exercise at all, start off small by doing something you like doing (e.g. dancing). Even 15 minutes of physical activity a day has shown to be beneficial.
NB! If you have risk factors for/or have established cardiovascular disease, you need to consult your doctor before starting an exercise programme to ensure that it is safe for you to do so.

Smoking increases the risk of developing CVD substantially, not to mention the increase in risk for other diseases, such as various cancers.
Second-hand smoke also needs to be avoided, as exposure to other peoples’ smoke increases your risk of CVD significantly.
Know your numbers!

As you can’t always see or feel the risk factors for CVD, you need to be tested regularly to assess your risk.
Have your weight, body mass index (BMI), waist circumference, blood pressure, cholesterol and blood sugar levels tested to determine your risk level.