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Angina is a pain or discomfort felt in the chest, usually caused by coronary heart disease. It often feels like a tightness in the chest which can spread to the arms, neck, jaw, back or stomach. People describe it as a severe tightness while others say it’s more of a dull ache, with shortness of breath too. It happens when the arteries that supply your heart muscle with blood and oxygen become restricted. It is often brought on by emotional upset, physical activity, cold weather or after meals but symptoms usually subside after a few minutes.
Each year about 20,000 people in the UK develop angina for the first time. It is more common in people over the age of 50 years and in men more than in women. Occasionally it also occurs in younger people.
Types of Angina
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Variant angina - which happens when a coronary artery supplying blood and oxygen to your heart goes into spasm.
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Microvascular angina - mostly occurs when you are exerting yourself during physical activity or emotional upset. With microvascular angina, the coronary arteries will appear normal when investigated and there will be no evidence of the fatty build-up in the arteries that usually causes angina.
Your GP may diagnose angina from the symptoms you describe or they may send you for other health checks and tests such as an ECG, coronary angiogram or heart scan.
Is Angina a Heart Attack?
No, because your heart is only getting a reduced blood flow for short periods, it is not getting any structural damage. A heart attack is where the blood flow becomes so reduced, your heart muscle becomes damaged. In angina, your heart muscle does not become damaged, and the pain should go away when you rest.
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Are There Any Risk Factors For Angina?
There are numerous risk factors that will make you more likely to develop angina. Some of the causes of angina are:
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High cholesterol levels
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Being overweight
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Diabetes
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Smoking
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High blood pressure
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Getting older
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Family history of heart disease
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Angina Symptoms
Your doctor might split your symptoms of angina into two groups, typical and atypical.
Typical symptoms of angina can feel a lot like a heart attack. You might experience:
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Chest pain – this may be a feeling of tightness across your chest, or it could be a dull ache. Some people describe a burning sensation.
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A pain that spreads to the following – shoulders, arms, neck, jaw. You might also get a tingling sensation in these areas.
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Pain when exercising, or when you feel stressed, and the pain goes away when resting for a few minutes.
Atypical symptoms include:
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Nausea
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A feeling of indigestion, or pain in the top part of your abdomen
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Extreme tiredness
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Feeling short of breath
Whether you get typical, or atypical symptoms doesn't really matter with regards to angina. It does not mean that you are getting it more severely, or less severely. For your doctor, it is important because it helps with diagnosing the actual problem. If you are suffering with only atypical symptoms, diagnosis may be more difficult, and you may require more tests before a confirmed diagnosis can be made.
Why is Angina An Important Warning Sign?
Angina is an important warning signal that the blood supply to your heart might not be as good as it should be. This means that you could be at greater risk of having a heart attack and that it may need further investigation. If it is the first time you have had it, then you will need some tests to make sure that the blood vessels around your heart are working well enough.
The first time you are diagnosed, you will undergo an assessment by your doctor to give an estimate of how likely you are to suffer a heart attack over the next few years. They will take a careful history, asking questions about how your symptoms initially started, what you were doing at the time, whether you have a family history of heart disease and more. The way you are investigated will depend on how high risk you are based on this history.
What is the Treatment For Angina
Medication is normally prescribed to help alleviate and control symptoms. Doctors may also suggest medication to reduce the risk of heart attack or stroke, meaning several different medications can be prescribed either fast-acting or long-term treatment. With several medications being taken daily for anyone who has angina, keeping daily doses organised is important and can be helped with useful medication aids and pill dispensers. If medication isn’t suitable or doesn’t help, surgery may be suggested in order to improve the blood flow to the heart muscles.
Medications which are used to reduce your risk of a further heart attack include:
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Aspirin – this drug is used to decrease the build-up of clots in your arteries.
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Beta-blockers – these drugs are frequently used for people with high blood pressure. A common example which is prescribed would be Bisoprolol. As well as reducing blood pressure, these beta-blockers also cause the heart to beat more slowly, and with less pressure. This means the heart isn’t working as hard, which can help with angina.
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Calcium Channel Blockers – if you can’t take beta-blockers, you may instead be given one of these drugs. They relax the arteries around your heart, increasing the blood supply to your heart muscle.
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Drugs to lower your cholesterol – having high cholesterol is a risk factor for heart attacks. The most common drugs prescribed for this are statins, such as Simvastatin.
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If you are found to suffer from high blood pressure, you may also be started on blood pressure medications. Beta-blockers and Calcium Channel Blockers do this, but if your blood pressure remains high, other medications may need to be added, such as an ACE inhibitor. A common example of an ACE inhibitor would be Ramipril.
Healthy Lifestyle Changes Can Also Include:
Another important way to reduce your risk of heart attack is to make some healthy lifestyle changes. These can reduce the need for some of the medications listed above. They are unlikely to be able to completely reverse the angina on their own, but are important in improving your overall health.
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Exercising at least three times a week, and for 30-minute intervals.
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Eating a healthy, well-balanced diet.
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Eat at least 5 portions of fruit and vegetables a day.
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Stop smoking.
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Drink within the recommended guidelines for alcohol consumption.
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The NHS Live Well website has some helpful advice, tips and tools on how to implement some healthy lifestyle changes. Having a healthy lifestyle is one of the most important things you can do to reduce your risk of having a heart attack and stroke. A quick summary of things to try are:
- Exercising at least three times a week, and for 30-minute intervals.
- Eating a healthy, well-balanced diet.
- Eat at least 5 portions of fruit and vegetables a day.
- Stop smoking.
- Drink within the recommended guidelines for alcohol consumption.
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The British Heart Foundation is a charity dedicated to supporting patients who suffer with heart conditions, angina included. They organise support groups and charity events. You can contact them via email, or for those who prefer to just talk to someone, they operate a helpline.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
- Abdomen – the section of the body that contains all of the structures between the chest area and the pelvis
- Arteries – blood vessels that carry oxygen-rich blood from the heart to body tissues
- Atheroma – a build-up of a clot inside of an artery
- Blood vessels – the channels through which blood is distributed to body tissues
- Cholesterol – a type of lipid; a fat-like substance that's produced naturally by the liver
- Clots – a semi-solidified mass, for example, of blood, or lymph
- Coronary Angiography – a scan using dye injected into the arteries to look at the blood vessels around the heart
- Diabetes – a condition when the body cannot product insulin which is required to control blood glucose levels
- Dilate – to enlarge, stretch, or cause to expand
- Echocardiogram – a scan using ultrasound waves to create an image of the heart in real-time. It can be used to show the structure of the heart, and how well it is pumping
- Electrocardiogram (ECG) – a tracing of the electrical activity of your heart onto a piece of paper. This is made by a machine which is connected to stickers which are placed onto your chest, and pick up the electrical activity in your heart. It can be used to identify heart attacks
- High blood pressure (hypertension) – recorded with 2 numbers (1) systolic pressure (the higher number) is the force at which the heart pumps blood around the body and (2) diastolic pressure (the lower number). High blood pressure puts strain on your blood vessels, heart and other organs such as the brain, kidneys and eyes
- Indigestion – a term that describes discomfort in the upper abdomen
- Nausea – the sensation of an urge to vomit (be sick)
- Percutaneous Coronary Intervention (PCI) – the placement of stents (small tubes) inside of arteries around the heart which have become narrow
- Statins – a class of prescription drugs to help lower cholesterol levels in the blood
- Stroke – occurs when the blood supply to part of the brain is interrupted, or reduced
- Troponin – an enzyme inside the heart muscle. If this enzyme is detected in the blood in high levels, it can indicate that you have had a heart attack
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