Angina

Angina is a heart condition that causes chest pain. It’s often described as an uncomfortable tight or heavy feeling in your chest, often on the left side. It happens when your heart muscle doesn’t get an adequate blood supply. The pain and discomfort can sometimes spread to your arms, jaw, tummy, neck and back. You may also feel short of breath or sweaty.

About angina

Angina is usually a symptom of coronary heart disease. If you have coronary heart disease, plaques of a fatty substance called atheroma build up in the walls of your blood vessels. This process is called atherosclerosis and it narrows your blood vessels. This restricts the flow of blood and oxygen to your heart muscle.

You’re likely to notice angina when your heart works harder than usual – for example, when you exercise or if you have emotional stress. Angina can be a sign that you may be at risk of serious health problems. It may lead to a heart attack, which can be life-threatening. But you can usually keep your angina symptoms under control with angina treatments and some healthy lifestyle changes.

If you’re reading this because you have chest pain now, go directly to our section: What to do if you have chest pain.

Causes of angina

Angina is usually caused by coronary heart disease. You’re more likely to have 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 heart disease
• are older
• are male

Symptoms of angina

The main angina symptoms are chest pain or discomfort.

• You may feel a heaviness or pressure in your chest, or like you’re being squeezed tightly.
• The pain or discomfort can be in the middle of your chest or spread to your back, jaw, arms, shoulders, and neck.
• The pain or discomfort doesn’t change when you move, breathe in or out or cough

For more information, see our section: What to do if you have chest pain.

If you have already been diagnosed with angina, see your GP as soon as you can if:

• your angina symptoms begin to change
• you get other symptoms such as feeling or being sick, sweating, or dizziness

What to do if you have chest pain

If you haven’t been diagnosed with angina

It can be difficult to tell the difference between angina and a heart attack because the symptoms can be similar. If you’ve never been diagnosed with angina, and you have chest pain which doesn’t go away after a few minutes, call 999. Other symptoms of a heart attack include shortness of breath, sweating and feeling sick.

See our infographic on how to spot a heart attack (PDF, 0.7MB) or click on the image below.

If you have been diagnosed with angina

If you’ve been diagnosed with angina and have an angina attack:

• stop what you’re doing, sit down and rest
• use your glyceryl trinitrate (GTN) spray or tablets (for more information, see our section: Treatment of angina)
• take a second dose of GTN after 5 minutes if the pain hasn’t eased
• call for an ambulance if your pain hasn’t eased 5 minutes after the second dose (10 minutes after your pain started). But call for an ambulance earlier than this if your pain is getting worse and you’re feeling unwell

Diagnosis of angina

Your GP may refer you to a heart specialist (a cardiologist) for tests or treatment.

Your doctor will usually ask you about:

• your symptoms
• your lifestyle and medical history
• your family’s medical history

They’ll also:

• examine you
• take your blood pressure
• listen to your heart and chest with a stethoscope

After that, you may need some tests, including the following.

• Imaging tests, such as a specialist computer tomography (CT scan) or specialist cardiac magnetic resonance imaging (MRI). These will check your coronary arteries (the vessels that supply your heart with blood), and sometimes scan your chest and tummy.
• Blood tests – to check your glucose and cholesterol levels and for other health problems.
• An electrocardiogram (ECG) – to show the electrical activity of your heart.
• An echocardiogram, either when you’re resting or exercising. This test uses ultrasound to make moving images of the structure of your heart.
• An invasive coronary angiogram. A dye is injected into your coronary arteries to make them show up on X-rays. It can show where a blood vessel is narrowed or blocked.

Self-help for angina

There are things you can do to help control your symptoms and stop angina getting worse.

• Know what to do if you have chest pain. And always have your glyceryl trinitrate (GTN) medicine with you. For more information, see our section: What to do if you have chest pain.
• Plan your activities to avoid things you know trigger your chest pain.
• If your angina starts to get worse, the pain gets more severe or you’re getting an angina attack more often, contact your GP.
• If you smoke, stop. Ask your GP or pharmacist for advice or look online for local stop-smoking services.
• If you’re overweight, try to lose the extra weight.
• Eat a healthy, balanced diet that’s low in saturated fat, salt, and sugar and high in fibre, fruit, and vegetables.
• Stick to the recommended limits for alcohol. The current guidelines are for adults to drink no more than 14 units of alcohol a week, and to spread this out over the week.

Keep active

Talk to your GP or nurse about how to exercise safely. They may be able to refer you to a cardiac rehabilitation programme.

• Aim to do at least 150 minutes of activity (where you feel slightly out of breath), or at least 75 minutes of vigorous intensity activity, or a mix of the two, per week. And do some activities to strengthen your muscles on two or more days a week. But check with your doctor first, as whether you can do these will depend on your personal circumstances.
• Choose activities such as walking, cycling, and swimming rather than very vigorous sports like weight-lifting.
• Pace yourself. Stop what you’re doing if you get chest pain, very breathless, or leg pain.
• Don’t exercise outside when it’s cold or very windy.

Your doctor may advise you to take your GTN medicine before you do some activities.

Driving with angina

If you have angina, you can probably drive as long as your symptoms are under control. But this varies from person to person and depends on which type of vehicle you drive.

• If you have a car or motorcycle licence, you don’t usually need to tell the Driver and Vehicle Licensing Agency (DVLA) about your angina. But don’t drive if you have any symptoms.
• If you drive a bus or lorry, you must tell the DVLA if you have angina. You won’t be able to drive until you’ve not had any symptoms for at least six weeks and have passed an exercise test.

It’s important to speak to your doctor about driving, and also to check with your insurance company.

Air travel

Most people with angina can travel by plane. But speak to your doctor first because this will depend on your symptoms.

• If you only get chest pain after a lot of activity and your symptoms or medicines haven’t changed, you should be able to travel as normal.
• If you get chest pain after a little activity but your symptoms or medicines haven’t changed, ask for help at the airport. Consider asking for oxygen to be available during your flight.
• If you get chest pain when you’re resting or your symptoms and/or medicines have changed recently, you may want to postpone your flight. Or you could travel with a medical escort and make sure oxygen is available during your flight.

Complications of angina

Angina can lead to complications, including:

• a stroke
• heart attack
• heart failure

If you have angina, you may find it harder to do some of your everyday activities. This may reduce the quality of your life. You may also worry about your angina symptoms. For some people, this may lead to depression.

Most people with angina can lead very active lives with few symptoms or complications if they make changes to their lifestyle and have treatment.