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.
There are two main types of 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 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.
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.
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:
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.
If you have angina, you’re more likely to have:
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:
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:
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.
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.
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.
There are many things you can do to help control your symptoms and stop your angina from causing further heart problems.
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.
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.
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.
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.
Most people can prevent angina by adopting a healthy lifestyle. This includes:
Produced by Polly Kerr, Bupa Health Information Team, May 2013.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
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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