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Angina

Angina describes the pain or discomfort felt in your chest when the flow of oxygen-rich blood in a coronary artery (a blood vessel that supplies your heart with blood) is restricted.

Angina is a symptom of coronary heart disease and affects about two million people over the age of 35 in the UK. You’re more likely to get angina as you get older and men are more likely to get it than women. Angina usually starts with chest pain or tightness when you’re doing some sort of physical activity. 

Types of angina

There are two main types of angina.

Stable angina

If you have stable angina, you’re likely to have regular or predictable symptoms that have lasted for more than two months. You’re likely to become familiar with what brings on your symptoms, for example it’s common to get symptoms when you exert yourself during normal activities. You can probably relieve your symptoms by resting or taking medicines that your doctor may have prescribed for you.

Unstable angina

Unstable angina is usually caused by the sudden narrowing or blockage of a coronary artery and can mean you’re at risk of having a heart attack. This may be the first time you have had angina or it may be that stable angina has become more severe. If you have unstable angina, the symptoms often come on after only a small amount of effort or even when you’re resting. Pain and discomfort may develop quickly and may not be helped by resting or taking medicines. If you get sudden chest pain or you think you may have unstable angina, call for emergency help immediately.

Angina and heart attack

If a coronary artery becomes completely blocked, part of your heart muscle may be starved of oxygen and become damaged. This is a heart attack. The pain you have happens usually at rest, is severe and lasts longer than that of angina. If you have angina, your usual treatment may not relieve the pain of a heart attack. If you suspect that you or someone else is having a heart attack, call for emergency help immediately.

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Preventing coronary heart disease
Dr Paul Zollinger-Read
Image showing a coronary artery affected by atherosclerosis

Details

  • Symptoms Symptoms of angina

    A number of things can bring on angina, such as physical activity, emotional stress or eating a large meal. Heat or, more commonly, cold weather can also cause angina symptoms. If you have angina, you may:

    • have pain or discomfort in your chest – this can feel dull, heavy or tight and it may spread to your jaw, neck, arms, back or stomach
    • feel sweaty
    • feel sick
    • feel short of breath

    Symptoms of angina may vary depending on what type you have. You may get very few symptoms – in particular, the symptoms in older people can be very different to those usually linked with angina.

    If you have stable angina and your symptoms change, for example, they come on after less exertion than before or they are more severe, see your GP as soon as possible. If you get angina symptoms at rest, call for emergency help immediately.

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  • Diagnosis Diagnosis of angina

    If you get pain or discomfort in your chest when you do physical activity, contact your GP as soon as possible. He or she will ask you about your symptoms and may tell you to call for emergency help. If your GP doesn’t think you need immediate medical attention, you will be asked to make an appointment to see him or her. He or she will examine you and may also ask you about your medical history.

    Your GP may ask you to have some tests including:

    • blood tests, such as a blood count (the number of various blood cells in your blood), glucose and cholesterol levels
    • blood pressure
    • an ECG (electrocardiogram) – this records the electrical activity of your heart

    Depending on the results of these, your GP may refer you for an exercise ECG. This is carried out while you’re walking on a treadmill or cycling on an exercise bike. This test is useful because doing an ECG when you’re resting may not show up any problems. Your GP may also recommend having further tests including the following.

    • A coronary angiogram. This uses an injection of a special dye into your coronary arteries to make them clearly visible on X-rays. It can show where there are blockages or narrowings in your coronary arteries.
    • A CT scan. This uses X-rays to make a three-dimensional image of your heart.

    If you get sudden pain in your chest that is still there when you're resting, call for emergency help immediately. Your GP may also tell you to call for emergency help. When you arrive at the hospital you will have some tests to find out whether you’re having a heart attack.

  • Treatment Treatment options for angina

    There are a number of treatment options for angina, as described below. Which treatments you are offered will depend on your personal circumstances. Your GP or cardiologist will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    Any conditions you have that are causing your angina, such as high blood pressure, will also be treated at the same time.

    Self-help

    There are many things you can do to help control your symptoms and stop your angina from causing further heart problems.

    • If you smoke, stop. Ask your GP or pharmacist for advice.
    • If you're overweight, try to lose excess weight.
    • Eat a healthy, balanced diet that is low in saturated fat, salt and sugar and high in fibre, fruit and vegetables. See our frequently asked questions for more information.
    • Try to eat oily fish, such as sardines or salmon, once a week.
    • Take regular exercise. Moderate aerobic exercise, such as brisk walking, cycling or swimming, is recommended. Get advice from your GP or nurse on how much exercise you can do and see our frequently asked questions for more information.
    • Don't exceed four units of alcohol a day for men or three units a day for women.
    • Reduce stress where possible. You may find that learning relaxation techniques will help you with this.
    • Attend regular check-ups with your GP to monitor your blood pressure and cholesterol levels.
    • If you have diabetes, it's important to closely control your blood sugar levels as advised by your GP or nurse.

    Medicines

    Medicines to relieve symptoms

    Your GP may prescribe you a medicine called glyceryl trinitrate (also known as GTN) that you can take to get immediate relief from your symptoms.

    GTN works by widening your coronary arteries so that more blood can flow to your heart. It commonly comes as a spray (used in your mouth) or it can come as a tablet that you dissolve under your tongue. GTN should relieve your pain within about five minutes but if it doesn’t, take another dose. If this doesn’t help or the pain gets worse, call for emergency help.

    If you have unstable angina, you will probably be given aspirin as soon as you get to hospital. This prevents your blood from clotting and reduces your risk of having a heart attack. Heparin is another medicine that prevents your blood from clotting. It's likely that you will be given heparin injections when you're in hospital if you have unstable angina.

    Medicines to prevent angina attacks

    Your doctor may also prescribe you medicines to take regularly to help control your symptoms and to try to prevent you from having further heart problems, such as a heart attack. You may be offered one, or a combination of, the following medicines.

    • Aspirin. If you have stable angina, your GP may advise you to take a small daily dose of aspirin to reduce your risk of having a heart attack. However, aspirin may increase your risk of stomach problems, such as ulcers, so it's not suitable for everyone. Speak to your GP for advice about taking aspirin.
    • Angiotensin-converting enzyme (ACE) inhibitors (eg ramipril). These widen your coronary arteries to increase blood flow to your heart and help lower blood pressure.
    • Beta-blockers (eg atenolol). These slow your heart rate and also its pumping action, which reduces its demand for oxygen. Beta-blockers may not be suitable if you have asthma.
    • Statins (eg simvastatin). These help to lower your cholesterol level and prevent fatty deposits building up in your coronary arteries. You may be given these to help prevent a heart attack even if your cholesterol level is normal.
    • Clopidogrel. This is an antiplatelet medicine that helps to prevent your blood from clotting.

    There is a variety of other medicines that your GP may suggest you try, which work in similar ways to those listed above. Your GP will talk to you about how these medicines may help you, and any potential side-effects of taking them. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Further treatment

    Your GP may refer you to a cardiologist to assess whether you would benefit from having a procedure or surgery. Your GP may refer you if medicines aren’t helping to control your symptoms, or if he or she thinks you may benefit from further treatment. A cardiologist is a doctor who specialises in conditions affecting your heart.

    Your cardiologist will talk to you about what other treatment options are available and whether they may be suitable for you. The main procedures for coronary heart disease are described below.

    • A coronary angioplasty can widen your narrowed coronary artery. In this procedure, your doctor will pass a collapsed balloon through your blood vessels until it reaches the arteries of your heart and then inflate it. He or she may insert a stent (flexible mesh tube) to help keep your artery open.
    • A coronary artery bypass graft (CABG) is a type of surgery. In the operation, your surgeon will take a piece of a blood vessel from your leg or chest and use it to bypass the narrowed coronary arteries. This can improve the flow of blood to your heart.

    Which procedure your cardiologist recommends, if any, will depend on your individual circumstances. He or she will discuss the benefits and risks with you to help you to decide whether to have a procedure.

  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Causes Causes of angina

    Stable angina is caused by a narrowing of your coronary arteries. Gradually, over time, fatty deposits build up on the walls of your coronary arteries and they become narrowed and hardened. This restricts blood flow to your heart and is known as atherosclerosis, which is the cause of coronary heart disease.

    Unstable angina is caused when a fatty deposit (plaque) bursts (ruptures) and a blood clot forms around the plaque. This can partially or completely block a coronary artery and suddenly reduce blood flow to part of your heart. The main cause of angina is coronary heart disease. You’re more likely to get coronary heart disease if you:

    • have high blood pressure
    • have diabetes
    • have high cholesterol
    • smoke
    • have an inactive lifestyle
    • are overweight
    • have a family history of coronary heart disease

    As well as coronary heart disease, other problems can lead to angina, including:

    • heart valve disease
    • anaemia (you don’t have enough red blood cells in your blood)
    • heart muscle disease (cardiomyopathy)
    • an irregular heartbeat (arrhythmia)
  • Complications Complications of angina

    If you have angina, you’re more likely to have:

    • a heart attack
    • heart failure
    • anxiety or depression
    • reduced quality of life – it may be more difficult to carry out everyday activities 
  • Prevention Prevention of angina

    Most people can prevent angina by adopting a healthy lifestyle. This includes:

    • not smoking
    • losing excess weight
    • doing 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more – for example by carrying out 30 minutes on at least five days each week
    • eating a low-fat, high-fibre diet with at least five portions of fruit and vegetables a day
    • not drinking more than four units of alcohol a day if you’re a man and three units if you’re a woman
  • How atherosclerosis develops How atherosclerosis develops

    Play video
    Coronary heart disease happens when fatty deposits build up
  • FAQs FAQs

    Can I drive if I have angina?

    Answer

    It’s very likely that you will be able to drive if you have angina. However, this will depend on how severe your condition is.

    Explanation

    If you’re diagnosed with angina and you drive any sort of vehicle, it’s very important that you tell your motor insurer otherwise your insurance may not be valid.

    If you drive a car, you don’t need to tell the Driver and Vehicle Licensing Agency (DVLA) about your angina provided that your condition is under control and you don’t get symptoms when you’re driving or resting. If this changes, stop driving immediately. Once your symptoms are relieved you can start driving again – check with your GP when it’s safe for you to do so.

    If you drive a large goods vehicle or a passenger-carrying vehicle, you will need to tell the DVLA that you have angina. You won’t be able to drive either of these vehicles if you get angina symptoms. You can return to driving once you haven’t had symptoms of angina for at least six weeks and you have completed a successful exercise test.

    I have angina – can I travel by plane?

    Answer

    You will probably be able to travel by plane if you have angina, but it will depend on how severe your condition is.

    Explanation

    You’re likely to be fine to fly if your angina only comes on after significant physical activity and your symptoms or medicines haven’t changed recently.

    If you get chest pain without doing much activity, you may want to consider organising to have some help at the airport and possibly arranging to have in-flight oxygen on the plane. During a flight there is often less oxygen in the atmosphere so there will be less in your blood. This may cause your angina symptoms to get worse and in-flight oxygen can help to relieve them.

    It’s important that you speak to your GP, airline and travel insurer if you’re planning on travelling by plane and:

    • you get chest pain at rest
    • there has been a recent change in your symptoms
    • the medicines you take for angina have recently changed

    You may be advised to wait until your symptoms are stable before flying. If it’s safe for you to travel, you may need to have a medical escort (a health professional who travels with you) and you’re likely to need in-flight oxygen.

    Can I exercise if I have angina?

    Answer

    Being physically active keeps your heart healthy and helps you to maintain a healthy weight. If you have angina, it's important to keep active but be careful not to do more than you’re able to with your condition.

    Explanation

    If you have recently been diagnosed with stable angina, your GP may recommend that you start going to a cardiac rehabilitation programme. These are designed to be specific to your needs and involve group-based exercise and advice and information sessions to provide you with support about your condition.

    There are many health benefits of an active lifestyle. Regular exercise can help to:

    • control your weight
    • maintain a healthy blood pressure
    • maintain a healthy cholesterol level
    • reduce stress and anxiety
    • improve your mobility, speed and stamina
    • improve your quality of life

    It's a good idea to do moderate exercise, such as walking, cycling or swimming, on at least five days each week. Aim to do at least 30 minutes of exercise on each of the days – you can do this all in one go or in shorter bursts of no less than 10 minutes. You should be able to talk comfortably as you exercise. It's important to increase your level of activity gradually and speak to your GP if you have any concerns.

    Do I need to change my diet if I have angina?

    By eating a healthy, balanced diet you can help to prevent your angina from getting worse. You will also reduce your risk of developing type 2 diabetes, maintain a healthy weight and lower your cholesterol level and blood pressure.

    There are many ways you can change your diet to make it as healthy as possible.

    • Aim to eat at least five portions of fruit and vegetables each day.
    • Limit the amount of salt, sugar and saturated fat in your diet.
    • Instead of frying or roasting food, boil, poach, grill or steam it.
    • Try to eat oily fish, such as sardines or salmon, at least once a week.
    • Stay within the recommended alcohol limits – four units a day if you’re a man and three units if you’re a woman.

    Changing your diet should be a gradual process. Small, day-to-day changes will have a much bigger and long-lasting effect. If you're having trouble making changes to your diet or you're worried that you're not getting all the nutrients you need, talk to your GP.

  • Resources Resources

    Further information

    Sources

    • Angina. British Heart Foundation. www.bhf.org.uk, published 1 October 2011
    • Angina – summary. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published May 2012
    • Angina. The Merck Manuals. www.merckmanuals.com, published February 2008
    • Chest pain of recent onset. Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. National Institute for Health and Care Excellence (NICE), published March 2010. www.nice.org.uk
    • Unstable angina and NSTEMI. The early management of unstable angina and non-ST-segment-elevation myocardial infarction. National Institute for Health and Care Excellence (NICE), published March 2010. www.nice.org.uk
    • For medical practitioners: DVLA at a glance guide to the current medical guidelines (for medical professionals). Driver and Vehicle Licensing Agency. www.dft.gov.uk, accessed 1 March 2013
    • Cardiac rehabilitation. British Heart Foundation. www.bhf.org.uk, published 1 July 2010
    • ACPICR standards for physical activity and exercise in the cardiac population. Association of Chartered Physiotherapists in Cardiac Rehabilitation. www.acpicr.com, published 2009
    • Radionuclide imaging. The Merck Manuals. www.merckmanuals.com, published December 2012
    • Angina pectoris – stable angina. American Heart Association. www.heart.org, published March 2013
    • Stable ischaemic heart disease. BMJ Best Practice. www.bestpractice.bmj.com, published January 2013
    • Stable angina – symptom control and risk reduction. Map of Medicine. www.mapofmedicine.com, reviewed 14 January 2013
  • Related information Related information

  • Author information Author information

    Produced by Polly Kerr, Bupa Health Information Team, May 2013.

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