Angina

Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
Next review due February 2023

Angina is when you have chest pain or an uncomfortable tight feeling in your chest because not enough blood is getting to your heart muscle. The pain and discomfort can sometimes spread to your arms, jaw, upper abdomen (tummy), neck and back.

Angina can be a sign that you’re at risk of serious health problems and can sometimes be life-threatening. But treatment and healthy lifestyle changes can reduce this risk and help keep your symptoms under control.

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

Older man walking

About angina

Angina is usually a symptom of coronary heart disease, caused by atherosclerosis. This is when plaques of a fatty substance called atheroma develop in the walls of your blood vessels and make them narrower. If this happens, not enough blood and oxygen can get to your heart muscle, especially when it’s working harder such as during exercise. Angina is the pain or discomfort you then feel. If the blood vessels become completely blocked, as can happen when a plaque ruptures, this can lead to a heart attack.

Image showing a coronary artery affected by atherosclerosis

For more information about who may develop angina, see our section ‘Causes of angina’.

Symptoms of angina

The main symptoms of angina are chest pain or discomfort that:

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

Your angina symptoms may differ a little depending on what type of angina you have. There are two main types of angina – stable and unstable.

Stable angina

For stable angina, the chest pain or discomfort usually:

only comes on when you’re being active, when you’re eating or when you’re upset or stressed; cold weather may also bring it on
lasts for around five minutes
is relieved by resting or by taking your angina medicine (see our section ‘Treatment of angina’)

If your symptoms begin to change, for example, they come on after less exertion than before or are more severe, see your GP as soon as you can.

Unstable angina

If you develop unstable angina, the chest pain may happen when you’re resting. It may happen more often than with stable angina, be more severe and last for longer. It may not be eased by your usual angina medicines.

You may have other symptoms too, such as:

feeling sick or vomiting
sweating
feeling light-headed or dizzy
being short of breath

Unstable angina can be serious and needs treating quickly. For more information, see our next section ‘What to do if you have chest pain’.

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 you have an angina attack, you should:

stop what you’re doing, sit down and rest
use your glyceryl trinitrate (GTN) spray or tablets (see our treatment section for information about these)
take a second dose of GTN after five minutes if the pain hasn’t eased
call for an ambulance if your pain hasn’t eased five minutes after the second dose, or earlier if your pain is getting worse and you’re feeling unwell

Diagnosis of angina

Your doctor will usually ask you about your symptoms, lifestyle, and your and your family’s medical history. They’ll also examine you, including taking your blood pressure and listening to your heart and chest with a stethoscope.

After that, your doctor may ask you to have some tests, including:

blood tests to check if you have other health problems, and to check your glucose and cholesterol levels
an electrocardiogram (ECG) – this shows the electrical activity of your heart

Depending on what the tests show and how severe your symptoms are, your GP may refer you to a heart specialist (a cardiologist) for more tests or for treatment. The other tests you have may include the following.

An exercise ECG. This is when you have an ECG taken while you’re exercising. It’s usually done when you’re walking on a treadmill or pedalling an exercise bike.
A chest X-ray.
Imaging tests, such as a computer tomography (CT scan) or magnetic resonance imaging (MRI). These may include scans of your chest, abdomen (tummy) and coronary arteries (the vessels that supply your heart with blood).
An echocardiogram, either when you’re resting or exercising. This test uses ultrasound to produce moving images of the structure of your heart.
A coronary angiogram. This is a procedure where a special 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 many things you can do to help control your symptoms, manage your condition and stop your angina from causing further heart problems.

Make sure you know what you should do if you have chest pain. For more information, see our section, ‘What to do if you have chest pain’. Always have your pain-relieving medicine with you.
Think ahead, pace yourself and spread your activities to prevent chest pain. Consider taking your pain-relieving medicines before exercise, to prevent an attack if you’re going to do something that might bring this on.
If your angina starts to get gradually worse, the pain becomes more severe or you’re getting an attack of angina 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 is low in saturated fat, salt and sugar and high in fibre, fruit and vegetables.
Be physically active. Talk to your GP or nurse (who may be a cardiac rehabilitation nurse) about how to exercise safely. See our frequently asked questions for more information.
Stick to recommended limits for the amount of alcohol you drink. 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.

Treatment for angina

There are several treatment options for angina, depending on what type you have and whether or not you have other health conditions as well.

Medicines

Medicine to treat angina attacks

If you have stable angina, your GP will prescribe a medicine called glyceryl trinitrate (GTN). This opens up your coronary arteries so that more blood can flow to your heart. GTN usually comes as either a spray or a small tablet that you put under your tongue. You take this when you have an angina attack. GTN works quickly, within a few minutes, and should help to ease the pain. You can also take GTN before doing activities that you know may trigger an angina attack.

Medicines to prevent angina attacks and further heart problems

Your doctor may prescribe medicines for you to take regularly to help prevent an angina attack and reduce your chance of having further heart problems. You may be offered one or more of the following medicines.

An anti-clotting medicine, such as aspirin or clopidogrel. These medicines help to prevent blood clots developing and can reduce the chance of having a heart attack.
Medicines to lower and control your blood pressure.
Anti-angina medicines, such as beta-blockers and calcium channel blockers. These help to reduce the symptoms of angina and prevent angina attacks.
Statins. These help to lower your cholesterol level to reduce your risk of having a heart attack in the future.
ACE inhibitors may be helpful in stopping heart disease getting worse if you have angina.

There are other medicines that your doctor may suggest you try, which work in similar ways to those listed above. They will talk to you about how these medicines may help, and any potential side-effects of taking them. Always read carefully the patient information leaflet that comes with your medicine. If you have any questions about taking your medicines, ask your pharmacist.

Surgery

If your symptoms aren’t getting better using medicines, your doctor may suggest an operation to either widen or bypass the narrowed blood vessels in your heart.

The two main procedures are:

A coronary angioplasty (also called percutaneous coronary intervention, PCI) can widen your narrowed coronary artery. In this procedure, your doctor will pass a thin tube into your artery. When it reaches the narrow part, your doctor will use a tiny balloon to widen the blood vessel. They’ll usually place a stent (a mesh tube) inside the blood vessel, which is then left in place to help keep the artery open.
A coronary artery bypass graft (CABG) operation. This is where your surgeon takes a piece of a blood vessel from your leg, arm or chest and uses it to bypass the narrowed blood vessel. This can improve the flow of blood to your heart muscle.

If your cardiologist recommends one of these procedures, they’ll tell you what’s involved and discuss the benefits and risks with you.

Causes of angina

Angina is usually caused by coronary heart disease. This is when the arteries bringing oxygen to the heart muscle become narrowed by plaques of fatty tissue. You’re more likely to develop 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

Other health problems can also cause angina. These include heart valve disease and heart disease caused by high blood pressure.

Complications of angina

Angina can lead to a number of complications, including:

heart attack
irregular heart rhythms
heart failure

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

Prevention of angina

You may be able to prevent angina by having a healthy lifestyle. This includes:

not smoking
losing excess weight
being physically active
eating a healthy diet that’s low in fat and salt, while high in fruit, vegetables, grains, pulses and beans
aiming to have two portions of fish a week, one of which should be an oily fish like sardines or salmon
staying within the recommended alcohol limits – the current guidelines are for adults to drink no more than 14 units of alcohol a week

A healthy heart is central to your overall health.

Your heart health is heavily influenced by your lifestyle, but largely these effects go under the radar.

Let's take you inside your heart so we can better understand how your lifestyle choices affect you.

Your heart is a muscle, and like any other muscle, it needs exercise to work properly.

During exercise your muscles work harder and need more oxygen, meaning your heart must beat faster to meet the demands of the body.

The more you work your heart, the bigger and stronger it gets.

Being active can reduce your risk of heart disease by as much as 35 percent, and any exercise is better than no exercise, so go at your own pace.

Smokers are twice as likely to develop a serious heart problem. With every cigarette you breathe in around 5000 chemicals, many of which are harmful to your health.

These chemicals cause the blood to thicken and form clots inside the veins and arteries, which can lead to coronary heart disease.

But these impacts are largely reversible.

Within a year of quitting smoking, you would have halved your risk of a heart attack or stroke.

Eating a healthy, balanced diet can counteract high blood pressure and cholesterol levels, both of which can harm your heart health.

Eating too much saturated fat is linked to increased levels of bad cholesterol in your blood.

This can cause fatty deposits to build up in your arteries, which over time can lead to heart disease or even a heart attack.

When you sleep, your heart gets a rest and your heart rate and blood pressure go down.

Not getting enough sleep regularly can lead to high blood pressure, diabetes and weight gain.

Everyone needs a different amount of sleep to feel rested, but in general, the average adult should be aiming for seven to nine hours each night.

By staying hydrated, you are helping your heart do its job.

It can pump blood more easily and get oxygen to your muscles more efficiently.

Most adults need around two to two and a half litres of fluid every day, with most of that coming from drinks and some from the food we eat.

Stress and unhealthy habits associated with it play a big part in your overall well being.

There's plenty of ways to manage your stress levels, explore your options, and find a solution that fits you, your lifestyle, work and personality.

All these factors play a huge part in helping us lead a healthy lifestyle, all of which keeps your heart, and yourself, happy and healthy.