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Angina is where you suffer pain in your chest which is caused by a lack of blood flow to your heart. It is not a heart attack, but could be a warning sign that you are at higher risk of having one.
Your heart has a special blood flow of its own. Much like every other part of your body, it needs a healthy supply to work properly. If the blood vessels ‘feeding’ the heart become narrowed by cholesterol, or clots, then this can restrict the amount of blood getting to your heart. This might occasionally cause chest pain, or discomfort, for short periods.
Your heart needs more blood when you are doing things like exercising than when you are relaxing and sitting down. For this reason, angina generally happens when you exercise. It can also occur when you get emotional, or stressed.
Angina is caused by narrowings in your blood vessels where a clot has built up. This clot is called an atheroma. These narrowings are generally contributed to by several different things, rather than having one singular cause.
Firstly, high blood pressure will put a strain on your arteries. This causes the walls of your arteries to shear (break off), in small amounts. A clot then builds up on the broken surface. This clot can be made up of platelets, cholesterol, and other fibres. If you have high cholesterol, you are more likely to build up these clots. The clot will just continue to build until it could eventually block the artery altogether. This is what causes a heart attack, and also what can cause certain types of strokes.
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.
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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Broadly speaking, there are two types of angina – stable and unstable. Stable angina is where you only get short periods of chest pain when exercising. Unstable is where the pain is more prolonged, or happens at rest. Your angina could also be classed as unstable if it is happening more frequently. For example, if you normally only get angina once a week, or when walking up a steep hill, but then you start to get it every day, and when only walking short distances, this would be unstable angina.
If you are suffering with symptoms of unstable angina, you must see a doctor. If you cannot get an urgent appointment with your GP call NHS 111 or attend A&E.
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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:
Atypical symptoms include:
Whether you get typical, or atypical symptoms doesn't really matter with regards to your 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.
If you haven’t been diagnosed with angina, and your pain has come on when you were exercising, or when feeling stressed, and it subsides within a few minutes of rest, call NHS 111 for an urgent appointment.
If your symptoms don’t go away with rest, call 999. You will need to go into a hospital to be assessed by a doctor to make sure that you are not having a heart attack.
If you are known to suffer with angina, you will likely have GTN prescribed by your doctor. GTN, or Glyceryl Trinitrate, is a drug which dilates the blood vessels around your heart. This improves your heart's blood supply and should ease your pain. Stop what you are doing and rest. Take your GTN whichever way you have been told to by your doctor. This might be in the form of a spray, or a tablet, which you put under your tongue and it then dissolves.
If your pain comes on whilst you are resting, or it is worse than usual, you should call 999. You should also do this if the pain does not go away within a few minutes.
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 you 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.
There are lots of different investigations you might end up getting. Which ones your doctor orders will probably depend on how high risk you are, and how you presented with your initial symptoms.
If your symptoms were severe, or happened more recently, you might receive blood tests. These will probably include a special test called a troponin, which gives an indication about whether your heart has suffered any damage. If it is raised, this means that your heart muscle has been damaged, and this is how a heart attack is diagnosed. In angina, we would expect this test to be normal.
Other tests include:
If you have unstable angina, or a coronary angiogram showing that the blood vessels around your heart have become very narrow, you might need surgery to prevent you from having a heart attack. This is likely to be done through the blood vessels in your groin, which means that you won’t end up with any large wounds.
A small tube called a stent is threaded with a wire through the artery in your groin, or possibly the artery in your wrist, and into any blood vessels which have been shown to be really narrow. This procedure is known as percutaneous coronary intervention, or PCI. The stent opens up the artery and hopefully, this means that they will not become blocked in the future, so avoiding a heart attack.
If this type of surgery isn’t an option, or you have multiple areas that need treating, then the treatment of angina might include a different type of surgery. People have classically heard of this type of surgery described as a “heart bypass”. People might describe it as being a “double heart bypass”, or “triple heart bypass”. Essentially, a blood vessel is taken from another part of your body and surgically “grafted” onto your heart to “bypass” any blood vessels which aren’t working as well as they should be. The number of vessels which you need to “bypass” leads to the “double” or “triple” description that people sometimes use.
If your angina is very stable, or no narrowings like this can be identified, you will probably not get any definitive treatment. You will be prescribed medications to reduce your risk of getting a heart attack in the future, and some medications to help deal with the pain when you get an attack.
The primary medication used to relieve symptoms is GTN, which we discussed earlier. Medications which are used to reduce your risk of a further heart attack include:
Another important way to reduce your risk of heart attack is to make some healthy lifestyle changes. These can reduce your need for some of the medications listed above. They are unlikely to be able to completely reverse your angina on their own, but are important in improving your overall health.
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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:
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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.
