Angina is chest pain which occurs when the blood supply to the heart becomes restricted because of narrowing or blockages in the blood vessels around the heart.
Symptoms of angina
The main symptom of angina is chest pain. This can:
- feel like a dull pain, ache, 'heavy' or 'tight' feeling in your chest
- spread to your arms, neck, jaw or back
- be triggered by physical exertion
Angina itself is not life threatening, but prolonged chest pain can be a symptom of a heart attack.
Immediate action required: Phone 999 immediately if:
You or someone else has symptoms like:
- central chest pain or discomfort in the chest that doesn't go away – it may feel like pressure, tightness or squeezing
- pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach
- seizures or fitting
- difficulty breathing (snoring or rasping)
- chest pain alongside breathlessness, nausea and sweating
Non-urgent advice: Speak to your GP if you:
- do not have a diagnosis of angina and experience chest pain on exercise that eases after a few minutes of resting
- have an angina diagnosis and your symptoms are becoming more frequent or occur at rest
If your GP is closed, phone 111.
To diagnose angina, you will be assessed and you may need to have several tests.
You will also be asked some questions about:
- the symptoms you experienced
- if there were any triggers for the pain
- your family's medical history
- lifestyle risk factors (like smoking, for example)
Tests for angina
You might also be given some tests to determine if you already have heart disease or you're at risk of it.
- measuring your weight
- measuring blood pressure
- taking blood to check cholesterol levels, diabetes or anaemia
If it's thought that you have angina, you might be referred to the hospital for some more tests. These might include:
- electrocardiogram (ECG) – measures the rhythms and electrical activity of the heart
- exercise tolerance test (ETT) – measures the activity of the heart during exercise
- myocardial perfusion scan (MPS or MYoview) – measures how well blood is reaching the heart
- coronary angiography – shows whether your coronary arteries are narrow and how severe any blockages are
- blood tests – help to identify increased enzyme levels (troponin) which are released when the heart is damaged
Types of angina
The 2 main types of angina are stable angina and unstable angina.
Stable angina is more common. Attacks are more likely to have a trigger (like physical activity or stress).
Symptoms of stable angina usually only last for a few minutes after exercise or stress. They can improve with rest and by taking a medication called Glyceryl trinitrate (GTN).
Attacks of unstable angina can be unpredictable and develop without any clear triggers. They might also last longer and continue even when resting.
Sometimes, when chest pain occurs suddenly, it's unclear if it's due to unstable angina or a heart attack. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS).
There are various ways to treat and manage angina.
If you have stable angina you may be given medicine to:
- prevent and treat angina attacks
- reduce your risk of a heart attack
Preventing and treating angina attacks
You may be given nitrates if you have stable angina. These work by relaxing the muscles in the blood vessels so that blood can pass through more easily.
You might be given nitrates as:
- slow release tablets
- a fast acting spray or tablet
Glyceryl trinitrate (GTN) is usually given in a fast acting spray or tablets. You should keep this with you at all times. If you experience an episode of angina you can use the spray or tablet under your tongue. The pain should then ease within a few minutes.
You can repeat the dose after 5 minutes if the pain has not gone away. If the pain has still not gone 5 minutes after you take the second dose you should call an ambulance.
Beta blockers work mainly by slowing down the heart.
Calcium channel blockers
Calcium channel blockers relax the arteries, increasing blood supply to the heart muscle.
If you cannot have beta blockers or calcium channel blockers, you may be given another medicine. Your doctor will discuss this with you.
Reducing your risk of a heart attack or stroke
To reduce your risk of more serious cardiovascular problems, your doctor might give you:
- a low dose of aspirin to prevent blood clots
- statins to reduce your cholesterol (blood fats) level
- ACE inhibitors to reduce your blood pressure
Worsening angina symptoms over a short period of time can be a sign of a more acute coronary syndrome and you should seek urgent medical advice by phoning 999.
If you have unstable angina (where symptoms develop unpredictably), you'll need certain medicines. These will prevent blood clots and reduce your risk of having a heart attack.
You may be given:
- low-dose aspirin
Surgery may be recommended if you continue to have angina attacks despite medical treatment. It may also be recommended if tests show that you're at a high risk of having a heart attack.
Surgery for angina
There are 2 types of procedures that are used to treat angina. These are a:
- coronary artery bypass graft (CABG)
- percutaneous coronary intervention (PCI)
The best option for you depends on your circumstances. You should discuss the different options with your doctor. It's likely that you will need to continue taking some medicines after surgery.
Coronary artery bypass graft (CABG)
A CABG is where a section of a blood vessel is taken from another part of the body. This is then used to re-route the flow of blood past a blocked or narrow section of artery.
Percutaneous coronary intervention (PCI)
PCI is where a narrowed section of artery is widened using a balloon and a tiny tube called a stent. It's also known as a coronary angioplasty.
04 January 2023
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