Overview

Angina is chest pain caused by reduced blood flow to the heart muscles. It's not usually life threatening, but it's a warning sign that you could be at risk of a heart attack or stroke.

With treatment and healthy lifestyle changes, it's possible to control angina and reduce the risk of these more serious problems.

Symptoms

The main symptom of angina is chest pain.

Chest pain caused by angina usually:

• feels tight, dull or heavy - it may spread to your left arm, neck, jaw or back
• is triggered by physical exertion or stress
• stops within a few minutes of resting

Sometimes there might be other symptoms like feeling sick or breathless.

When to seek medical help

If you haven't been diagnosed with angina, get an urgent GP appointment if you have an attack of chest pain that stops within a few minutes of resting.

They can check if it might be a heart problem and refer you to a hospital for tests.

Call 999 for an ambulance if you have chest pain that doesn't stop after a few minutes - this could be a heart attack.

Types

There are 2 main types of angina you can be diagnosed with:

• stable angina (more common) - attacks have a trigger (such as stress or exercise) and stop within a few minutes of resting
• unstable angina (more serious) - attacks are more unpredictable (they may not have a trigger) and can continue despite resting

Some people develop unstable angina after having stable angina.

Treatment

You'll probably need to take several different medicines for the rest of your life.

You may be given medicine to:

• treat attacks when they happen (only take when needed)
• prevent further attacks
• reduce the risk of heart attacks and strokes

If medicines aren't suitable or don't help, an operation to improve blood flow to your heart muscles may be recommended.

Living with angina

If it's well controlled, there's no reason why you can't have a largely normal life with angina.

You can usually continue to do most of your normal activities.

One of the most important things you'll need to do is to make healthy lifestyle changes, such as:

• have a balanced diet
• cut down on alcohol
• stop smoking if you smoke
• lose weight if you're overweight
• exercise regularly - gentle exercises are usually safe

This can help reduce your risk of heart attacks and strokes.

Causes

Angina is usually caused by the arteries supplying blood to the heart muscles becoming narrowed by a build-up of fatty substances.

This is called atherosclerosis.

Things that can increase your risk of atherosclerosis include:

• an unhealthy diet
• a lack of exercise
• smoking
• increasing age
• a family history of atherosclerosis or heart problems

Symptoms

The main symptom of angina is chest pain. Some people also have other symptoms.

Chest pain

Chest pain could be angina if it:

• feels tight, dull or heavy - although some people (especially women) may have sharp, stabbing pain
• spreads to your left arm, neck, jaw or back
• is triggered by physical exertion or stress
• stops within a few minutes of resting

Other symptoms

Angina can also cause:

• breathlessness
• feeling sick (nausea)
• pain in your lower chest or belly - similar to indigestion
• feeling very tired

Some people have these symptoms without obvious chest pain.

What to do if you have symptoms of an angina attack

If you haven't been diagnosed with angina:

1. Stop what you're doing and rest.
2. Make an urgent appointment to see your GP if the symptoms go away in a few minutes
3. Call 999 for an ambulance if the symptoms don't stop in a few minutes - this could be a heart attack
4. If aspirin is easily available and you're not allergic to it, chew 1 tablet while waiting for an ambulance - this can help if you're having a heart attack.

If you have already been diagnosed with angina:

1. Stop what you're doing and rest.
2. Take the medicine prescribed for you (glyceryl trinitrate, or GTN, spray or tablets).
3. Take another dose after 5 minutes if the first one doesn't help.
4. Call 999 for an ambulance if you still have symptoms 5 minutes after taking the second dose.

Diagnosis

You may need to have several tests to diagnose angina.

Seeing a GP

If you see a GP after an attack of chest pain, they may ask about:

• the symptoms you had
• what you were doing when the symptoms started
• your lifestyle - for example, what your diet is like and if you smoke or drink
• your family's medical history - heart problems can run in families

They may also do some checks to assess the likelihood of a heart problem, such as:

• measuring your blood pressure
• calculating your body mass index (BMI) - this involves measuring your weight and height
• measuring your waist size
• blood tests to check your cholesterol (blood fats) level

If they think you might have angina or another heart problem, they may refer you to hospital for some tests.

Tests in hospital

You may have tests to check if you have angina and assess your risk of more serious problems like heart attacks or stroke.

You may have:

• an electrocardiogram (ECG) - a test to check your heart's rhythm and electrical activity
• a coronary angiography - a scan taken after having an injection of a dye to help highlight your heart and blood vessels
• an exercise ECG - an ECG carried out while you're walking on a treadmill or using an exercise bike
• blood tests

What happens if you have angina

What happens next depends on the type of angina you're diagnosed with.

There are 2 main types:

• stable angina (the most common type) - attacks have a trigger (such as exercise) and improve with medicines and rest
• unstable angina (the more serious type) - attacks are more unpredictable and can continue despite resting

If you have stable angina, you'll be given medicines to treat attacks when they occur and reduce the risk of further attacks.

If you have unstable angina, you may need to stay in hospital at first. Some checks will be done to assess your chances of having another attack and help decide on the best treatment.

Treatment

Treatment can help stop angina attacks and reduce the risk of further problems like heart attacks.

Most people with angina need to take several medicines. Surgery may be recommended if medicines don't help.

It's also important to make healthy lifestyle changes.

Medicines

Medicines to treat attacks

If you have stable angina (the most common type), you'll be given medicine to take when you have an angina attack.

This is called glyceryl trinitrate, or GTN. It comes as a mouth spray or tablets that dissolve under the tongue.

If you have an angina attack:

1. Stop what you're doing and rest.
2. Use your GTN medicine.
3. Take another dose after 5 minutes if the first one doesn't help.
4. Call 999 for an ambulance if you still have symptoms 5 minutes after taking the second dose.

You can also use GTN to avoid an attack before doing something like exercise. You may have a headache, flushing or dizziness soon after using it.

GTN tablets usually expire about 8 weeks after the packet is opened, at which point you'll need to replace them. GTN spray lasts much longer, so may be more convenient.

Medicines to prevent attacks

To help avoid more attacks, you'll also need to take at least 1 other medicine every day for the rest of your life. Some people need to take 2 or more medicines.

The main medicines used to prevent angina attacks are:

• beta-blockers - to make the heart beat slower and with less force
• calcium channel blockers - to relax the arteries, increasing blood supply to the heart muscle

If you can't have either of these medicines, you may be given another medicine such as ivabradine, nicorandil or ranolazine.

Medicines to prevent hearts attacks and strokes

Angina is a warning sign that you're at a higher risk of serious problems like heart attacks or strokes.

You may also need to take extra medicines to reduce this risk.

These include:

• low-dose aspirin to prevent blood clots
• statins to reduce your cholesterol (blood fats) level
• ACE inhibitors to reduce your blood pressure

Surgery

Surgery may be recommended if medicines aren't helping control your angina.

The 2 main types of surgery for angina are:

• coronary artery bypass graft (CABG) - a section of blood vessel is taken from another part of the body and used to reroute blood around a blocked or narrow section of artery
• percutaneous coronary intervention (PCI) - a narrowed section of artery is widened using a tiny tube called a stent

Both of these operations are similarly effective. The best one for you depends on your circumstances. If surgery us recommended, talk to your doctor or surgeon about your options.

You'll probably need to continue taking some medicines after surgery.

Unstable angina

If you have unstable angina (where symptoms develop unpredictably), you'll need medicines to prevent blood clots and reduce your risk of having a heart attack or stroke.

You may be given:

• low-dose aspirin
• clopidogrel
• an injection of a blood-thinning medicine soon after you're diagnosed

Surgery (either CABG or PCI) may be recommended if you have a high risk of having another angina attack, or you're at a high risk of having a heart attack or stroke.

Living with

If your symptoms are well controlled and you make healthy lifestyle changes, you can usually have a normal life with angina.

Diet and lifestyle

Angina is a warning sign that you're at risk of serious problems like heart attacks and strokes.

To reduce the risk of problems like these, you should:

• have a balanced diet
• cut down on alcohol
• stop smoking if you smoke
• lose weight if you're overweight

Exercise and sport

It's also important to stay active if you have angina.

You might worry that exercising could trigger your symptoms or cause a heart attack, but the risk is low if you:

• build up your activity level gradually and take regular breaks
• keep your GTN spray or tablets with you
• if needed, use the spray or take a tablet before starting exercise

Speak to your GP if you're not sure it's safe for you to exercise.

Work

If you work, you can usually continue to do so.

Make sure you keep your GTN medicine with you just in case you have an attack at work.

If your job involves heavy lifting or manual labour, speak to your employer about changes you can make to reduce the risk of an attack.

This may mean changing your duties or cutting back on how much heavy work you do.

Having sex

Some people worry that having sex will trigger an angina attack, but the risk of this happening is low.

If you're worried about having an attack during sex:

• keep your GTN medicine nearby so you can use it quickly if needed
• consider using your medicine just before having sex to reduce the risk of an attack

Driving

You can usually keep driving if you have angina.

You only need to stop if your attacks occur at rest, while driving, or are triggered by emotion. You can start driving again when your symptoms are well controlled.

Ask your GP if it's safe for you to drive.

You don't need to tell the DVLA about your condition if you only have a car or motorcyle licence. You must tell the DVLA if you have a bus, coach or lorry licence.

Getting support

Living with angina can be difficult at times.

Speak to your GP if you have been feeling down for a few weeks. They may recommend treatments that can help, such as medicines or talking therapy.

You might also find it useful to use a support group such as the British Heart Foundation (BHF).