Symptoms of angina usually only last a few minutes. A number of things can bring on angina, such as physical activity, stress or eating a meal. Cold weather can also cause symptoms. If you have angina, you may have pain or discomfort in your chest – this can feel dull, heavy or tight. The discomfort may spread to your jaw, neck, arms, back or stomach. You may also have symptoms such as feeling short of breath, feeling sick (nauseous), having stomach pain or burping. You’re more likely to have these symptoms if you’re older, a woman or if you have diabetes.
These symptoms are not always caused by angina, but if you have them, see your GP. If your symptoms change, for example, they come on after less exertion than before or are more severe, contact your GP as soon as possible. If you get symptoms when you’re resting or they last for more than a few minutes you could have unstable angina. Call for emergency help immediately. Other symptoms of unstable angina (or a heart attack) include feeling sweaty, feeling sick and being short of breath.
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. You can call for emergency help by dialling 999 and telling the emergency services that you’re unwell and have chest pain.
If your GP doesn't think you need immediate medical attention, they will ask you to make an appointment to see them. At the appointment, he or she will examine you and ask you about your medical history.
Your GP may ask you to have some tests including:
- blood tests, such as a blood count (to check the number of various blood cells in your blood), glucose and cholesterol levels
- a blood pressure check
- an electrocardiogram (ECG) – this records the electrical activity of your heart
- a chest X-ray – this can help to look for other conditions that may be causing your symptoms
If these tests show you may have angina, your GP may refer you to a rapid access chest pain clinic. When you visit the clinic, you may be advised to have the following tests.
- Imaging tests, such as a CT scan of your coronary arteries (the vessels that supply your heart with blood). A CT scan uses X-rays to make a three-dimensional image of your body.
- Stress echocardiogram. This test uses ultrasound to produce moving images of your heart. It’s usually carried out just after or during exercise.
- Magnetic resonance perfusion. This involves having an MRI scan and an injection of a special dye. An MRI scan uses magnets and radio waves to produce images of the inside of your body. This test can help to show the blood supply of your heart.
- 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.
If you get sudden pain in your chest that does not go away 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’ll have some tests to find out whether you’re having a heart attack.
There are a number of treatment options for angina, as described below. Which treatments you’re recommended will depend on your symptoms and general health. 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 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.
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 your extra 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 less meat and more oily fish, such as sardines or salmon, once a week.
- Exercise regularly. Get advice from your GP or nurse on how much exercise you can do. See our frequently asked questions for more information.
- Don’t have more than four units of alcohol a day if you’re a man, or three units a day if you’re a woman.
- Reduce stress where possible. You may find that exercise, yoga or 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 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. You can also take GTN before doing activities that you know may trigger an angina attack.
Medicines like GTN work 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 as a tablet to 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. Your doctor may also suggest aspirin while you wait for a diagnosis.
If you have unstable angina, you’ll 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. You’ll also probably be given an antithrombin therapy (eg fondaparinux or heparin), which prevents your blood clotting.
Medicines to prevent angina and further heart problems
Your doctor may prescribe medicines for you to take regularly to help control your symptoms and reduce your chance of having further heart problems. You may be offered one or more of the following medicines.
- Aspirin. If you have stable angina, your GP may advise you to take a small daily dose of aspirin. This may help to reduce your risk of having a heart attack. Aspirin is not suitable for everyone, for example it can cause stomach problems.
- Clopidogrel. This is an alternative to aspirin that helps to prevent your blood from clotting. You may also be advised to take clopidogrel in addition to 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, which reduces the amount of work it needs to do and the amount of oxygen it needs. Beta-blockers may not be suitable if you have asthma.
- Calcium channel blockers (eg amlodipine). These relax your blood vessels, allowing more blood to get to the heart.
- 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.
There are 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.
If medicines aren't helping your symptoms, you may be advised to have an operation. If you have unstable angina, you’re also likely to need a procedure.
The main procedures for coronary heart disease are described below.
- A coronary angioplasty (also known as percutaneous coronary intervention) can widen your narrowed coronary artery. In this procedure, your doctor will pass a collapsed balloon through your blood vessels. When it reaches the arteries of your heart, they will inflate it. He or she may insert a stent (flexible tube) to help keep your artery open.
- A coronary artery bypass graft (CABG) is a type of surgery. Your surgeon will take a piece of a blood vessel from your leg, arm or chest. They will use this 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 symptoms and general health. He or she will discuss the benefits and risks with you to help you to decide whether to have the procedure.
Stable angina is usually caused by a narrowing of your coronary arteries. Gradually, over time, fatty deposits build up in the walls of your coronary arteries. This makes them narrow and hardened, which restricts blood flow to your heart. This is known as atherosclerosis, which is the cause of coronary heart disease. Symptoms happen when the reduced blood flow means that your heart is not getting the amount of oxygen it needs.
Unstable angina is caused when a fatty deposit (plaque) breaks open and a blood clot forms around it. 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
- have an inactive lifestyle
- are overweight
- have a family history of coronary heart disease
- are older
As well as coronary heart disease, other problems can lead to angina, including:
- heart valve disease
- heart muscle disease (cardiomyopathy)
- high blood pressure
If you have angina, you’re more likely to have:
- a heart attack
- reduced general health and quality of life – it may be more difficult to carry out everyday activities
You may also find you have symptoms of anxiety or depression.
Heart attacks can be life-threatening, so it’s important to seek immediate emergency help if you develop signs of a heart attack.
Most people can prevent angina by adopting a healthy lifestyle. This includes:
- not smoking
- losing excess weight
- being physically active
- eating a healthy diet (low in fat and high in fruit, vegetables, grains, pulses and beans)
Can I drive if I have angina?
Whether or not you’ll be able to drive will depend on when you get symptoms and what treatment you've recently had.
You can drive a car if your angina is controlled and you don’t get symptoms triggered by your emotions, when you’re driving or resting. If you meet these criteria, you don’t need to tell the Driver and Vehicle Licensing Agency (DVLA) about your angina. If your condition 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’ll need to tell the DVLA that you have angina. You won’t be able to drive either of these vehicles if you get symptoms. You can return to driving once you haven’t had symptoms of angina for at least six weeks and you have passed an exercise test.
If you have an angioplasty or coronary artery bypass graft (CABG), you must stop driving for a while to allow yourself to recover. If you have an angioplasty, you can’t drive a car for at least a week. You also can’t drive a heavy goods vehicle or passenger-carrying vehicle for at least six weeks. If you've had a CABG, you can’t drive a car for at least 4 weeks. You also can’t drive a heavy goods vehicle or passenger-carrying vehicle for at least 3 months. Speak to your GP or contact the DVLA for more information about when you’re allowed to drive again.
If your job involves driving, be sure to talk to your employer about your condition. They may be able to arrange for you to chat about any issues you have with your occupational health department. Many people who have angina are still able to work as normal, although you may need to make some changes to parts of your work.
If you don’t follow the medical advice of the DVLA, your insurance might not cover you if you’re involved in an accident. You should also check your insurance if you have any type of surgery.
I have angina – can I travel by plane?
Whether or not you’ll be able to travel by plane if you have angina, will depend on how severe your condition is.
You may be able to fly if your angina only comes on after large amounts of 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 arranging to have some help at the airport. You may also want to organise having in-flight oxygen on the plane. During a flight there is often less oxygen in the atmosphere, so there could be less oxygen in your blood too.
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 when you’re resting
- 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, a specialist may arrange for you to have a medical escort (a health professional who travels with you). Make sure you have the right travel insurance before you travel.
Can I exercise if I have angina?
Being physically active keeps your heart healthy and helps you to keep 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.
If you have stable angina, your GP may recommend exercise to reduce the chances of your having more heart problems in the future. Regular exercise can help to keep your heart healthy by:
- helping you keep a healthy weight
- lowering your blood pressure
- reducing your risk of getting diabetes
- improving the function of your blood vessels
- improving the way your body breaks down fats
Get advice from your GP or nurse on how much exercise you can do. It’s important to increase your level of activity gradually. Don’t exercise so hard that you get angina or become very breathless. Avoid exercising in the cold, in strong winds, or when you have chest pain. Your doctor may advise that you take glyceryl trinitrate (also known as GTN) before doing some activities.If you can walk briskly up and down two flights of stairs, it should be safe for you to have sexual intercourse. Speak to your GP if you have any questions or concerns.
Do I need to change my diet if I have angina?
It’s important to eat healthily to look after your heart and prevent your angina from getting worse.
By eating a healthy, balanced diet you can help to prevent your angina from getting worse. You may also reduce your risk of other heart problems, developing type 2 diabetes, and high blood pressure. Eating the right foods can also help you to keep your weight healthy.
You can make your diet as healthy as possible by doing the things below.
- 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.
- Stay within the recommended alcohol limits – four units a day if you’re a man and three units if you’re a woman. Have at least two days without alcohol each week.
A Mediterranean diet is thought to be good for reducing your risk of heart disease. This involves reducing the amount of meat in your diet and having fish, fruit and vegetables, grains, nuts, pulses and beans.
It’s best to change your diet gradually, so you find it easier to stick to the changes. Choose up to two or three things to change at a time. 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.
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