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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.

an info-graphic detailing how to spot a heart attack

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.
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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:


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

Frequently asked questions

  • Many people with angina can carry on driving, as long as their symptoms are under control. Whether or not you have to tell the Driver and Vehicle Licensing Agency (DVLA) about your angina depends on the type of driving licence you have.

    You should check with your insurance company to see if having angina affects your policy.

    Driving with a car or motorcycle license

    You don’t need to tell the DVLA that you have angina. However, you must not drive if you get angina symptoms at rest, while driving or brought on by emotion. You can drive again when your symptoms are under control.

    If you’ve had coronary angioplasty to treat your angina, you should stop driving for at least a week afterwards. If you’ve had a coronary artery bypass graft (CABG), you must stop driving for at least a month.

    Driving with a bus, coach or lorry licence

    If you drive a bus or lorry, you must tell the DVLA if you have angina. You won’t be able to drive any of these vehicles if you get symptoms. You can drive a bus or lorry again when you haven’t had symptoms of angina for at least six weeks and you’ve passed an exercise test.

    If you’ve had surgery to treat your angina, you must tell the DVLA. After coronary angioplasty, you should stop driving your bus or lorry for at least six weeks. After a coronary artery bypass graft (CABG), you must stop driving these vehicles for at least three months.

  • Most people with angina will be able to travel by plane. These are the recommendations for air travel if you have angina.

    • If you only get chest pain after a lot of activity and your symptoms or medication haven’t changed, you can travel as normal.
    • If you get chest pain after a little activity but your symptoms or medication haven’t changed, you should ask for help at the airport. You should also consider asking for oxygen available during your flight.
    • If you get chest pain when you’re resting or your symptoms and/or medication have changed recently, then you may want to postpone your flight. If you can’t do that, then you could travel with a medical escort and make sure you have oxygen available during your flight.

    Talk to your doctor for more information. You should also let your travel insurer know about your condition, and keep them updated if your symptoms change before you travel. If you do not do this, you may not be covered by your travel insurance.

  • Your doctor will encourage you to be regularly active to keep your heart healthy and to prevent any further heart problems.

    Talk to your doctor or nurse on how much activity you should be doing. It’s important to increase the amount you’re doing gradually, to make sure you don’t put too much strain on your heart. Here are some tips.

    • Aim to do about half an hour of activity on four or five days of the week.
    • Do activity at a level that makes you feel warm and slightly out of breath.
    • Choose activities like walking, cycling and swimming. Don’t lift weights or do very vigorous sports like squash.
    • Pace yourself. Stop what you’re doing if you get chest pain, become very breathless or develop leg pain.
    • Don’t exercise outside when it’s cold or very windy.

    Your doctor may advise you to take glyceryl trinitrate (also known as GTN) before doing some activities.



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Related information

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    • Unstable angina. BMJ Best practice. bestpractice.bmj.com, last reviewed December 2019
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    • Driving and medical conditions. GOV.UK. www.gov.uk, accessed February 2020
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, February 2020
    Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
    Next review due February 2023

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