Angina

What is angina?

Angina causes pain in the chest that feels tight or heavy and can make you breathless. You might sometimes hear doctors call it ischemic chest pain.

It’s usually caused by coronary heart disease – where your coronary arteries become narrowed by a build-up of fatty substances. When the blood flow to your heart is restricted, it makes your heart work with less oxygen, which can lead to chest pain.

While it’s not usually life-threatening, it should be taken seriously as it’s often a sign that you’re at higher risk of a heart attack or stroke.

Angina symptoms

The key symptom of angina is chest pain, although this can affect people differently. Symptoms include:

• An aching or burning sensation

• Tight feeling in your chest

• A feeling of heaviness or pressure on your chest

• Shortness of breath

• Tiredness

• Feeling dizzy

• Pain that may spread to your arm, neck, jaw or back

Types of angina

The two main types of angina are:

1. Stable angina – The most common form of angina triggered by something like stress or exercise. The pain goes away when you rest for a few minutes.

2. Unstable angina – The angina attacks can happen without a trigger and may continue even if you rest. This can develop from stable angina and is more serious, so it’s important to see a doctor immediately.

Angina risk factors

Angina pain is caused by coronary heart disease and several factors put you at higher risk of developing it:

• Older age

• Smoking

• An unhealthy lifestyle, like poor diet and lack of exercise

• Family history of heart problems

• Other health conditions like high blood pressure and high cholesterol

• Obesity

• Stress

Angina diagnosis

Your GP will start by asking about your symptoms, your lifestyle and your family medical history.

They may also take some of the following tests:

• Blood pressure

• Blood tests to check your cholesterol level

• Measuring your height and weight to calculate your Body Mass Index (BMI)

If they think you have angina, you may be referred to the hospital for further tests. These might include:

• Electrocardiogram (ECG) – This checks your heart's rhythm and activity. They may also carry out an exercise ECG where you walk on a treadmill or use an exercise bike while your heart is monitored

• Coronary angiography – First, you have an injection of dye, followed by a scan to look at your heart and blood vessels

Angina treatment

Treatment for angina includes medication and surgery, and it’s also important to make changes to your lifestyle.

The treatment you have will depend on the type of angina and how serious it is. It can include:

• Nitrate medication – If you have stable angina, this can be taken before doing something that usually triggers an attack to try to prevent it, such as exercising, or when you have an attack to try to stop it.

• Medication to prevent further angina attacks – Ongoing preventative medicines, like beta blockers, to slow down the heartbeat.

• Medication to prevent heart attacks or stroke – You may be recommended further drugs like statins, aspirin or ACE inhibitors to reduce your risk of more serious health problems.

• Surgery – If the medication doesn’t help control your angina attacks, surgery may be recommended. This can involve widening the affected artery with a stent (percutaneous coronary intervention) or rerouting blood around a blocked artery (coronary artery bypass graft).

Lifestyle changes

Making healthy lifestyle changes can be a significant factor in controlling the symptoms of angina. Consider whether you could make some helpful improvements to your health in the following areas of your life:

• Diet –It’s important to eat a healthy diet and try to avoid too much processed food, saturated fat, sugar and salt.

• Lifestyle – Are you a smoker or do you drink more than is recommended? These are both important risk factors for further heart problems.

• Weight – What is your BMI? Discuss your weight with your doctor and get advice on losing weight if it’s too high.

• Being active – It’s important to stay fit and active, but you will need to exercise carefully by building up slowly and factoring in regular breaks. If you’ve been prescribed nitrate medication, take it before your exercise or have it with you in case of an angina attack.

Angina recovery

Remember that angina is a warning sign that you’re at risk of a heart attack or a stroke. If you make healthy lifestyle changes and talk to your doctor about treatment, it’s usually possible to control the symptoms and learn to live with angina.