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Angina

Key points

  • Angina can be stable or unstable – unstable angina is a medical emergency.
  • Angina affects about two million people over the age of 35 in the UK.
  • Symptoms of angina include chest pain and tightness.
  • Angina is caused by the narrowing or blockage of a coronary artery.
  • The condition can often be controlled with lifestyle changes and medicines.
  • Reduce your risk of angina by eating a healthy, balanced diet, exercising regularly and not smoking.

Video: How atherosclerosis develops

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.

About angina

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.

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.

Complications of angina

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

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:

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)

Illustration of a coronary artery affected by atherosclerosis.

Video: how atherosclerosis develops

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 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.

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

 

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

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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