Angina

What is angina?

Angina is chest discomfort caused by narrowed coronary arteries limiting blood supply to the heart muscle, typically during exertion or stress. It is a warning sign of coronary artery disease rather than a heart attack, because the muscle is not yet dying. Stable angina follows a predictable pattern; discomfort that appears at rest or is worsening needs urgent assessment.

Causes

• Atherosclerotic narrowing of the coronary arteries
• Coronary artery spasm in variant angina
• Microvascular disease of small heart vessels
• Severe anaemia reducing oxygen delivery
• Aortic valve disease

Symptoms

• Chest tightness, pressure or heaviness
• Discomfort brought on by exertion, cold or emotion
• Relief within minutes of resting
• Discomfort spreading to the arm, neck or jaw
• Breathlessness on exertion
• Symptoms relieved by a GTN spray

Risk factors

• Smoking
• High blood pressure and cholesterol
• Diabetes
• Family history of early heart disease
• Obesity and physical inactivity
• Increasing age

Diagnosis

• History of exertional discomfort relieved by rest
• Resting ECG, which is often normal
• CT coronary angiography as first line in many guidelines
• Exercise or stress imaging tests
• Invasive coronary angiography where intervention is likely
• Blood tests for cholesterol, glucose and anaemia

Treatment

• Glyceryl trinitrate spray for episodes
• Beta blockers or calcium channel blockers to prevent them
• Aspirin and a statin to reduce heart attack risk
• Blood pressure and diabetes control
• Angioplasty with stent for limiting symptoms
• Coronary artery bypass surgery in extensive disease
• Cardiac rehabilitation and structured exercise

Self care

• Carry your GTN spray at all times
• Sit down before using GTN, since it can cause dizziness
• Learn which activities trigger symptoms and pace accordingly
• Stop smoking completely
• Exercise regularly within the level your doctor advises
• Eat a Mediterranean style diet and reduce salt
• Keep cholesterol and blood pressure medicines going daily

When to see a doctor

Book an appointment if:

• New chest discomfort on exertion
• Angina occurring more often or with less effort
• Needing GTN more frequently than usual
• Breathlessness that is worsening
• Side effects from heart medicines
• Before starting a new exercise programme

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Stop smoking
• Control blood pressure, cholesterol and diabetes
• Regular physical activity
• Healthy weight and Mediterranean style diet
• Limit alcohol
• Attend cardiovascular risk assessment

Outlook

Stable angina is usually manageable for many years with medicines and risk factor control, and many people continue working and exercising normally. It does signal underlying coronary disease, so treatment focuses as much on preventing heart attack and stroke as on relieving symptoms. Angina that changes pattern or occurs at rest is unstable and carries a much higher short term risk.

Related conditions

Common questions