Angina
Chest pain caused by a reduction in the flow of blood to the heart muscles
What is angina?
Angina, also known as angina pectoris, is a type of chest pain which is experienced when your heart muscles do not receive enough oxygenated blood. The pain often feels like heaviness, tightness or pressure in the chest. Angina is not a disease, but rather a symptom of an underlying heart problem. It can be caused by conditions including aortic stenosis, diabetes, anaemia or hypertrophic cardiomyopathy, however in the majority of cases, it is a symptom of coronary artery disease.
Although angina itself is not life-threatening, coronary artery disease is a very serious condition which puts you at risk of a stroke or heart attack. If you experience angina, or any unexplained chest pain, then you should make an appointment to see your doctor immediately.
What causes angina?
Angina is caused by a reduction in blood flow to your heart muscle. It is almost always an underlying symptom of coronary artery disease (a form of heart disease).
Angina is chest pain which is caused when one or more of the coronary arteries become narrowed. This narrowing is usually the result of a build-up of fatty acids (also known as plaques) inside the artery. This narrowing of the arteries (known as atherosclerosis) means that the heart muscle does not always receive the oxygen it needs, leading to angina. Angina symptoms can be brought on by different triggers, including physical activity and stress.
Although angina is commonly a symptom of coronary artery disease, this is not always the case. For example, Prinzmetal's angina (also known as vasospastic angina) is caused by sudden spasms in a coronary artery, and not by atherosclerosis associated with coronary artery disease. Microvascular angina is another rare type of angina. It affects the tiny arteries in the heart (known as micro vessels), causing them to become blocked or go into spasm, even in people without coronary artery disease.
However, in the majority of cases, angina is the result of atherosclerosis caused by coronary artery disease. Causes of atherosclerosis include:
- Smoking
- Being overweight
- Not getting enough exercise
- Age (older people are at greater risk)
- Eating an unhealthy diet
- A family history of coronary artery disease
- Stress
It may be possible to reduce your risk of angina (and coronary artery disease) by giving up smoking, maintaining a healthy weight, leading an active lifestyle and eating a healthy, balanced diet.
What does angina feel like?
Not everyone experiences angina in the same way, and different types of angina can cause different symptoms. Many people describe angina as a pain which can feel like tightness, heaviness, dullness or pressure, or which feels like a heavy weight pressing on their chest.
Although the symptoms of angina vary, most people describe it as:
- Pain, discomfort, a burning sensation or pressure in the chest
- A feeling of fullness in the chest
- Sharp, stabbing pains in the chest (this is more common in women than men)
- Chest pain which spreads to your arms, neck, jaw or back
- Chest pain which is triggered by exercise or exertion
Types of angina
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Stable angina icon plus
This is the most common type of angina. It is characterised by chest pain which is brought about by physical exertion, such as stress or exercise, and usually lasts around 5 minutes. Most people with stable angina find that it disappears after resting for a few minutes, or after taking angina medication. -
Unstable angina icon plus
This is more serious than stable angina. Attacks can be unpredictable (nor related to stress or exercise), with no obvious trigger. Attacks of unstable angina are usually longer (lasting up to 30 minutes), may not respond to angina medication and may continue even after you have rested.
People who have previously been diagnosed with stable angina can sometimes develop unstable angina. An attack of unstable angina can sometimes signal a heart attack, so you should call an ambulance immediately.
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Microvascular angina (previously known as cardiac syndrome X) icon plus
This is a rare type of angina, which affects the tiny arteries in the heart (known as micro vessels), causing them to become blocked or go into spasm. Symptoms of microvascular angina can be different to the usual pain associated with stable angina and may include:
- Chest pain which can last up to 30 minutes and may be more severe than for other types of angina
- Pain which may be accompanied by shortness of breath, sleep problems, fatigue or lack of energy
- Chest pain at times of stress (such as during exercise) or when resting
- Symptoms similar to anxiety or panic attacks
Microvascular angina can be difficult to diagnose, as common tests for angina look for signs of coronary artery disease. In the case of microvascular angina, only the small arteries of the heart are affected, and these don’t show up on traditional scans or angiograms.
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Variant (Prinzmetal) angina icon plus
Variant angina (also known as vasospastic or Prinzmetal angina) is caused by sudden spasms in a coronary artery, and not by atherosclerosis (narrowing of the arteries associated with coronary artery disease). In most cases, variant angina flares up at times of rest, and not during periods of stress or exercise. Typically, attacks occur between midnight and 8am. Attacks of variant angina can be brought on by:
- Cold weather
- Stress
- Medicines which constrict (tighten) blood vessels, for example certain migraine medicines
- Smoking
- Cocaine use
Variant angina is quite rare, and can usually be treated with medication and lifestyle changes.
Symptoms of angina
Common symptoms of angina include:
- Pain, discomfort, a burning sensation or pressure in the chest
- A feeling of fullness in the chest
- Sharp, stabbing pains in the chest (this is more common in women than men)
- Chest pain which spreads to your arms, neck, jaw or back
- Chest pain which is triggered by exercise or exertion
If you have angina, your chest pain may be accompanied by other symptoms, including:
- Dizziness
- Fatigue
- Nausea
- Sweating
- Shortness of breath
- Abdominal pain (this is more common in women than men)
Angina symptoms in women
Sometimes, women with angina experience different symptoms to men. This is probably because women are more likely to be diagnosed with microvascular angina or variant angina, which have slightly different symptoms. Women with angina are more likely to experience symptoms including:
- Chest pain (although this may not be the most prevalent symptom)
- Shortness of breath
- Abdominal pain
- Nausea
- Stabbing pains in the chest
- Discomfort in the neck, jaw or back
If you are a woman and experiencing any of these symptoms, then don’t ignore them. Speak to your doctor and arrange for further tests, so that a proper diagnosis can be made.
How is angina diagnosed?
If you have had symptoms of angina, or experienced an angina attack, then it’s important to arrange to see your doctor as soon as possible. In order to diagnose angina, your doctor will first ask you a range of questions, including:
Medical history: any existing medical problems you may have, including your family history (angina and heart problems can run in families)
Symptoms: you will need to describe your symptoms, how severe they were and how long they lasted
Activity: What you were doing when the symptoms began (e.g. whether you were under stress, engaged in a strenuous activity, etc.)
Lifestyle factors: these will include whether you smoke, whether you follow a healthy diet, whether you lead an active lifestyle, or have any other risk factors for angina
Your doctor will also carry out a physical examination, which will include:
- Blood pressure check: high blood pressure is often related to angina
- Listening to your chest and heart sounds through a stethoscope
- Check your BMI: this stands for body mass index, and measures whether you are a healthy weight for your height. High BMI (being overweight or obese) is related to angina and coronary artery disease
- Measurement of your waist (men with a waist size over 37in and women with a waist size over 31.5in are at high risk of coronary artery disease)
If your doctor thinks that you may have angina, coronary artery disease or another heart problem, they will refer you for further investigations and tests. These may include:
Blood tests: these provide information about your heart muscle by measuring the enzymes, cholesterol and proteins in your blood
Electrocardiogram (ECG): in this test, sensors are attached to your chest and the rate, rhythm and electrical activity of your heart are measured. It is a painless test which usually only takes a few minutes to complete
Exercise ECG (also known as a cardiac stress test): this is an ECG which is carried out whilst you are walking on a treadmill, to see how your heart responds to moderate exercise. This test usually takes around half an hour, and you will be monitored by a consultant throughout. You blood pressure will also be recorded
Cardiac CT scan: a high definition CT scan looking at the arteries surrounding your heart
Coronary angiogram (also known as cardiac catheterisation): during this procedure a small, flexible tube is inserted into your artery, at the top of your leg or in your arm, and a fine wire is guided along the arteries of your heart. A dye is then injected and a series of X-rays are taken, so that the consultant can see whether your coronary arteries are narrowed or blocked. An angiogram is a non-surgical procedure which is carried out under local anaesthetic, within a catheterisation lab or theatre. If blockages are detected in your coronary artery, they may carry out a coronary angioplasty (see below)
Coronary angioplasty: this is when a balloon is used to inflate a narrowed artery, which is then held open by a stent (a small wire tube). This procedure can be used to treat the symptoms of angina, and also as an emergency treatment following a heart attack
Other imaging tests: these include MRI for chest pain and PET scans, which provide high-definition images of your heart and surrounding arteries
Your doctor will decide which tests are most appropriate for you.
If you are worried about angina and would like to speak to a GP, HCA offers same-day and next-day private GP appointments.
Angina treatment
If you think you may have angina, then it’s extremely important to see your doctor and get a diagnosis as soon as possible. The right treatment can significantly relieve the symptoms of angina, as well as decreasing the risk of heart attack or stroke.
If you are diagnosed with angina, there are several different treatment options available. They include:
Medication
GTN: most people with stable angina will be prescribed a medicine called glyceryl trinitrate (GTN), which comes in spray form, or as tablets which dissolve under your tongue. You should take GTN as soon as you feel an angina attack coming on. GTN works by dilating your arteries, which puts less pressure on the heart muscle
Beta blockers: these are sometimes prescribed to prevent angina attacks. Beta blockers slow down the heart, by reducing the amount of adrenaline your body produces
ACE (Angiotensin-converting enzyme) inhibitors: these drugs reduce blood pressure by helping to relax your veins and arteries
Calcium channel blockers: these prevent calcium from entering your arteries and heart, helping the blood vessels to relax and reducing blood pressure
Aspirin: this helps to thin the blood and prevent heart attacks and strokes in people with angina
Statins: these are used to lower blood cholesterol, which helps prevent blockages in the blood vessels
If you are diagnosed with unstable angina, then your doctor may also prescribe a medicine called Clopidogrel, which prevents blood clots from forming.
If your angina is very serious, or if medication does not relieve symptoms, then your doctor may recommend surgery.
Procedures
There are two main types of procedure to treat coronary artery disease. These are:
Coronary Artery Bypass Graft (CABG): this is heart surgery, where an artery from another part of your body (usually in the chest, leg or arm), is attached above and below the blocked section of the coronary artery, to divert the blood flow (this is known as a graft). The operation is carried out under general anaesthetic (which means you will be asleep throughout the procedure), and lasts for between 3 and 6 hours. You may need more than one graft, depending on how severe your coronary artery disease is
Coronary Angiogram and stent insertion: this is a procedure performed in a cardiac catherisation laboratory when a balloon is used to inflate a narrow artery, which is then held open by a stent (a small wire tube). This procedure can be used to treat the symptoms of angina, and also as an emergency treatment following a heart attack
In addition to medication and surgical options, your doctor will probably recommend making some lifestyle changes to treat your angina. These are likely to include:
- Eating a healthy diet and maintaining a healthy weight (losing weight if necessary)
- Cutting down on alcohol
- Giving up smoking
- Trying to avoid stress
- Taking regular exercise: you will need to start slowly and build up your activity level gradually. Ask your doctor for advice before starting a new exercise regime
Living with angina
If you are diagnosed with angina, then there is no reason you can’t go on to lead a long, healthy life, as long as you make the necessary changes to your lifestyle and follow the course of treatment recommended by your doctor.
Eating a healthy diet, losing weight, keeping physically active, avoiding stress, reducing your alcohol intake and giving up smoking are all changes that you can make to improve your lifestyle. Doing so will relieve your angina symptoms, prevent your coronary artery disease from getting any worse, and reduce your risk of heart attack and stroke (in addition to many other illnesses including cancer and type 2 diabetes).
With the right treatment, most people with angina can continue to work, drive, and enjoy physical activity (including a normal sex life).
If you are finding it hard to come to terms with your angina diagnosis, or would like to talk to someone in the same position as yourself, then the British Heart Foundation has a number of useful resources.
At HCA UK, we also offer an dedicated cardiac rehabilitation service, which supports cardiac patients through their long-term recovery, promoting wellbeing through exercise, lifestyle management and education.
FAQs about angina
Is angina hereditary?
What are the risk factors for angina?
In addition to a family history of coronary artery disease, risk factors for angina include:
- High blood pressure
- High cholesterol
- An unhealthy diet
- Smoking
- Lack of physical activity
- Drinking too much alcohol
- Age: men over the age of 45 and women over 55 are more likely to be affected by angina than younger people
Certain medical conditions, such as congenital heart defects and unmanaged diabetes can also increase your risk of angina and coronary artery disease.
Can angina be cured?
If your angina is not too severe, then following your doctor’s recommendations about lifestyle changes including diet and exercise may be sufficient treatment. However, in more serious cases, medication and even surgery may be required.
In most cases, angina is a warning sign that you are at risk of a heart attack or stroke. Although there is no cure for coronary artery disease - of which angina is a symptom - making the necessary changes to your lifestyle and receiving appropriate treatment can reduce symptoms and prevent the condition from getting any worse.
Does angina cause high blood pressure?
Many people with angina will also have high blood pressure. This is because angina is one of the most common symptoms of coronary artery disease, which is also related to high blood pressure.
If you have angina, then high blood pressure can make symptoms worse, by placing additional pressure on the heart.
Making healthy changes to your lifestyle will improve the symptoms of angina and help reduce high blood pressure.
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