Heart conditions - angina

Angina is temporary chest pain or discomfort that happens when your heart does not get enough blood and oxygen. It is a symptom of an underlying heart condition, usually coronary heart disease, in which the arteries supplying the heart muscle become narrowed by a build-up of fatty material (plaque).

Unlike a heart attack, angina does not cause permanent damage to the heart muscle.

Symptoms of angina#

Different people experience angina in different ways, and symptoms can range from mild to severe. The pain or discomfort may feel like heaviness, pressure, tightness or squeezing in your chest. You may also feel it in your shoulders, back, neck, jaw or arms. Some people feel chest discomfort but have no pain at all.

Other symptoms of angina can include:

• Shortness of breath
• Dizziness
• Fatigue

Talk to your doctor if your angina:

• Happens at night or when you are resting
• Becomes more severe
• Happens more often
• Lasts longer
• Does not respond as well to medicine
• Happens with less exertion

Angina action plan#

There are several steps you should take as soon as you feel angina symptoms.

1. Stop and rest immediately.
2. If rest does not relieve your symptoms, take one dose of your angina medicine (available as a spray or a dissolvable tablet). Sit or lie down first, because the medicine can make you feel dizzy. Take the smallest dose that works for you (for example, a full, a half or even a quarter of a tablet). For a spray, use one dose under the tongue. For a tablet, place it under your tongue but do not swallow it; when your symptoms stop, spit out what is left.
3. Wait five minutes.
4. If the angina continues, take another dose of medicine.
5. Wait another five minutes.
6. Tell someone how you are feeling, or call a relative or friend.

Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) and ask for an ambulance if the angina:

• Gets worse quickly
• Is severe
• Is not completely relieved within the 10 minutes you have waited

Ask for an ambulance, do not hang up, and wait for advice from the operator.

Triggers and types of angina#

Angina can stop and start, and an episode can last from seconds to minutes. It often happens when your heart is working harder than usual and needs more oxygen-rich blood than the narrowed arteries can deliver. Common triggers include:

• Physical exertion
• Emotional stress
• Eating a large meal
• Cold temperatures

There are several types of angina:

• Stable angina is usually triggered by physical exertion or emotional stress. The symptoms often ease after a few minutes of rest and can also be relieved by angina medicine.
• Unstable angina can occur at any time, and often happens while resting. The symptoms may not improve with rest or medicine and can last longer than stable angina.
• Vasospastic angina (also known as Prinzmetal or variant angina) is rare and often severe, but can be relieved with medicines. It can happen at rest when spasms in the coronary arteries cause them to narrow or tighten.
• Microvascular angina (also known as cardiac syndrome X) may be a symptom of coronary microvascular disease, which affects the smallest blood vessels of the heart. The discomfort can be more severe and last longer than stable angina.

Risk factors#

Several factors can increase your risk of coronary heart disease and angina, including:

• Unhealthy eating patterns
• Excessive alcohol drinking
• Being physically inactive
• Tobacco smoking
• Stress
• Overweight or obesity
• High cholesterol
• High blood pressure
• Diabetes
• Having a mental health condition such as anxiety or depression
• Increasing age
• Being male
• Being a post-menopausal woman
• A family history of coronary heart disease
• Ethnicity, as some populations have a higher risk of coronary heart disease

Diagnosing angina#

To diagnose angina, your doctor will review your symptoms, ask about your family history of heart disease and examine you. They may also arrange one or more of the following tests:

• Blood tests, to measure your cholesterol levels and other markers of heart disease
• An electrocardiogram (ECG), to measure the electrical activity of your heart
• An exercise stress test, in which the heart is monitored with an ECG while you ride a stationary bike or walk on a treadmill. The test is stopped if you experience angina.
• A coronary angiogram, in which a long, thin tube (catheter) is inserted into an artery in your wrist (or sometimes the groin) and threaded up to your heart. A special dye is injected and an X-ray is taken, showing where the coronary arteries are narrowed or blocked by plaque.

Treatment#

Angina treatment reduces the frequency and severity of symptoms. It also lowers your risk of a heart attack by treating other underlying conditions. Angina can be treated and managed with medicines, lifestyle changes and surgery.

Medicines#

Nitrate medicines (for example, glyceryl trinitrate or GTN) are commonly prescribed to widen your blood vessels and increase blood flow to your heart. They are available in many forms, including a spray and patches. Some nitrate medicines are used to relieve angina, while others are taken every day to help prevent it.

If you have coronary heart disease, you may also need other medicines to reduce your risk of a heart attack. These can include:

• Antiplatelets, to reduce the risk of blood clots forming
• Beta blockers, to lower blood pressure and help regulate your heart rate and rhythm
• Calcium channel blockers, to widen your blood vessels, increase blood flow to the heart and lower blood pressure
• Cholesterol-modifying medicines, to reduce your cholesterol levels

Always take your medicines as prescribed by your doctor to help prevent, treat and manage angina and to lower your risk of further heart problems.

Lifestyle changes#

Making lifestyle changes can help prevent angina and reduce your risk of a heart attack. They include:

• Quitting smoking and limiting exposure to second-hand tobacco smoke
• Being physically active most days of the week
• Following a heart-healthy eating pattern
• Drinking less alcohol
• Looking after your mental health
• Maintaining a healthy body weight
• Managing your blood pressure and cholesterol levels
• Managing your blood sugar levels if you have diabetes

Surgery#

Some people may need surgery if medicines and lifestyle changes are not relieving their angina. The two main types are:

• Coronary angioplasty and stent insertion, a procedure to open a narrowed or blocked coronary artery using a balloon. Once the artery is open, a small expandable wire mesh tube (stent) is left in place to keep it open and the balloon is withdrawn. This improves blood flow to your heart.
• Coronary artery bypass graft (CABG) surgery, an operation in which a healthy blood vessel (a vein or artery from your arm, leg or chest) is attached to either side of the blocked artery so blood can flow to your heart again.

Living with angina#

Taking your medicines as prescribed and making lifestyle changes can lower your risk of worsening angina and further complications, including a heart attack.

Living with a heart condition like angina can also cause feelings of anxiety and stress in some people. If you are worried about how you are feeling, talk to your doctor and seek support from your loved ones.

Key points#

• Angina is a symptom of an underlying heart condition, usually coronary heart disease
• Unlike a heart attack, angina does not cause permanent damage to the heart muscle
• Different people experience angina in different ways, and symptoms can range from mild to severe
• Have an angina action plan, and call for an ambulance if the pain is severe, gets worse quickly, or is not relieved within 10 minutes
• Angina can be managed with medicines, lifestyle changes and, in some cases, surgery

Where to get help#